If insurance covers estradiol in pill form will they cover injectables too?

[Angélique LaCava]

I've been seeing mixed things online. In my opinion if they cover one method they should cover all, but I want to hear people who actually have experience with that.

[TonyaW]

Working as a retail pharmacist for more years than I want to say, I can tell you that most prescription plans exclude most injectable drugs.  Obvious exception is insulins and such.  You'll really need to call your plan if you can't find out any other way.  It's possible that a different part of the insurance plan would cover it if the prescription part does not.  Your pharmacist might be able to run a test claim for you to check coverage also.

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[Laurie]

Only the insurance provider can answer this for you Angelique.

Hugs,
   Laurie

[natalie.ashlyne]

Mine excludes injection so I would call your insurance company

[Angélique LaCava]

I just called my insurance and they said it needs a pre authorization so most likely they will cover it since they covered my pills and I needed a pre authorization for them aswell.

[Barb99]

When I switched from pills to injections my co-pay went from $10 to $192! A couple of calls to the insurance company determined that the doctor had to change the script to allow generic which brought the co-pay down to $72 and the quantity had to be under 30 and that would bring the co-pay down to $10.

The doctor originally wrote the quantity as the number of doses I would get out of the vial. Why the insurance company would make a fuss over this is when it is still the same 5ml vial no mater what the quantity states is beyond me, but dropping the quantity to 5 magically dropped the co-pay, so now I'm happily paying $10 per vial. The US health insurance system is a bit insane!

[Laurie]

When I switched from pills to injections my co-pay went from $10 to $192! A couple of calls to the insurance company determined that the doctor had to change the script to allow generic which brought the co-pay down to $72 and the quantity had to be under 30 and that would bring the co-pay down to $10.

The doctor originally wrote the quantity as the number of doses I would get out of the vial. Why the insurance company would make a fuss over this is when it is still the same 5ml vial no mater what the quantity states is beyond me, but dropping the quantity to 5 magically dropped the co-pay, so now I'm happily paying $10 per vial. The US health insurance system is a bit insane!

  The US health insurance system is not insane. They are greedy, plain and simple. They are big business and as such making a profit in every way they are allow to is what businesses do. It is what our current president and his rich buddies are all about. It's Greed and nothing more.

Laurie

[Barb99]

  The US health insurance system is not insane. They are greedy, plain and simple. They are big business and as such making a profit in every way they are allow to is what businesses do. It is what our current president and his rich buddies are all about. It's Greed and nothing more.

Laurie

Ahhhh, but I define greed as a symptom of insanity. But that's just me!

[AnneK]

Ahhhh, but I define greed as a symptom of insanity. But that's just me!

Many execs are in fact psychopaths.  There have been all too many examples where they put their own personal gain ahead of the business, sometimes destroying the business in the process.

https://en.wikipedia.org/wiki/Snakes_in_Suits

[Angélique LaCava]

Do y'all know if my clinic can give me so many months of viles and syringes to take home and just bill my insurance so I don't have to pay any co pay?

[TonyaW]

I just called my insurance and they said it needs a pre authorization so most likely they will cover it since they covered my pills and I needed a pre authorization for them aswell.

There is a big cost difference so you'll most likely need the doctor to give a reason why you can't take the pills.  Not getting the desired response from the pills SHOULD be good enough. Never know with insurance companies though.

When I switched from pills to injections my co-pay went from $10 to $192! A couple of calls to the insurance company determined that the doctor had to change the script to allow generic which brought the co-pay down to $72 and the quantity had to be under 30 and that would bring the co-pay down to $10.

The doctor originally wrote the quantity as the number of doses I would get out of the vial. Why the insurance company would make a fuss over this is when it is still the same 5ml vial no mater what the quantity states is beyond me, but dropping the quantity to 5 magically dropped the co-pay, so now I'm happily paying $10 per vial. The US health insurance system is a bit insane!

Most if that would be due to the difference in cost.  Also depends on plan coverage, (higher copay tier for non formulary or preffered drugs) days supply (if your vial lasts more than a month, you might need to pay multiple months copay).

Not dealing with insurance is one big reason I'm glad I don't work retail any longer.


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[TonyaW]

Do y'all know if my clinic can give me so many months of viles and syringes to take home and just bill my insurance so I don't have to pay any co pay?

Very unlikely.  Planned Parenthood charges based on income and other clinics may also.  Best you could probably do is a there month supply if your insurance allows. 

One other possibility is that your plan may cover more of it if it's given at the clinic.  You'd have to go to the clinic every week , 10 days, 2 weeks or whatever to get your shot then.

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[SadieBlake]

I once paid full price for my estradiol valerate and it was only $80 (Perrigo generic, not Par Delestrogen which costs about double). I was reimbursed the $70 difference be that and my copay price.

For most people that would be a 2-3 month supply, so even without insurance imx it's not so awful. Just had a look online and several pharmacies are in the $45-65 range.

YMMV of course