Prescription Insurance Coverage???

[AmyNYC]

Until recently I've had to pay cash for all of my medication.  But since I lost my job in February I applied for NY state health insurance (medicaid) and was accepted.  I tried to fill a prescription for Avodart (an anti-androgen specifically for men with prostate problems), but since the woman who processed my insurance application listed me as female, Walgreen's couldn't fill the prescription on my insurance because "it says the medication isn't covered for your gender?"  The pharmacist tried explaining to me it was because the medicine was for prostate problems and women don't take it.  I told him to keep the prescription and I'd figure it out, then high-tailed it out of there.

I'm just curious, has anyone else experienced this with their insurance programs, and is this something you should expect with most insurance programs?    I thought about calling the insurance people and explaining why I need the medicine, but then they may decide not to cover any of my medicine because they don't want to cover transsexual treatment.

Why can't things just go right?  It's just a reminder of the fact that I'm not a normal girl

Amy

[Annie Social]

What a pain in the butt...

I'm on the ususal regimen (spiro, estradiol, and progesterone), and started out paying for it myself. The estradiol and progesterone are cheap (I get them through my doctor's office and he supplies them at cost), but the spiro is pretty pricey, so I started putting that on my insurance. I figured that since it is prescribed to men for high blood pressure it wouldn't raise any red flags, and so far, so good.

You seem to be stuck in just the opposite situation; what really stinks is that if you were listed as male, there wouldn't be a problem! Could you switch to a different anti-androgen, one that is routinely prescribed to women? I think I remember hearing that spiro is sometimes prescribed for women with facial hair.

I would also check into the exact policies of the NY system to see if they specifically exclude medication for transgender issues. If not, a phone call may straighten out the situation. You may want to contact the Sylvia Rivera Law Project (www.srlp.org); they have a legislative initiative in the works covering some of these issues, and may be able to provide you with information.

At any rate, good luck!

Annie

[Melissa]

My insurance (that ends today) did not cover estradiol because it was not for the gender they have me listed as, but they did cover the spiro (more expensive of the 2).  I assume that this would reverse once they had me listed as female.  The reason they do this is to cut costs as well as, IMO, weed out helping TS's and possibly avoid fraud.

Melissa

[AmyNYC]

Yeah, I'm kinda screwed either way, because I take two medications that would most likely not be covered if I was listed as male, i.e. estrogen and progesterone.  The Avodart isn't covered for females, but I think Spironolactone might be.  The instructions for Avo-Dart specifically say women SHOULD NOT take the medication, but the instructions for spironolactone just say don't take it if you are or might become pregnant.

I guess I'll just have to pay for some of my meds until I'm post-op.  Of course if given the choice, I would much rather be listed as female and pay a little more money    When I applied for the insurance the ID I showed was my passport which lists me as female.  But when strangers have filled out forms for me using my driver's license (which clearly has "M" for sex), they still put female.  The two most recent were when a state trooper gave me a speeding ticket he put female, and when I bought a fishing license the guy put female.

Isn't it an interesting world we live in  

Amy

[LostInTime]

Sorry to hear about that.  I keep waiting to be told the same with mine but so far, so good.  Even after putting the femme name on the insurance, they did not bat an eye.  *looking out for that other shoe up there*

Good luck and please let us know if the spiro ends up being covered.

[HelenW]

So, the DOCTOR wrote the prescription but the INSURANCE COMPANY decided it wasn't the right thing for you?

This is so typical of the stupid arrogance that insurance companies (yes, even Medicaid, apparently) present when it comes to their rules and regulations designed to minimize their obligations.  Doesn't the state send out a description of what and what's not covered?  Maybe there is something in the fine print (tedius but necessary, unfortunately) that will clarify the rules.

Perhaps a call from the doctor to the insurance carrier can make it right?

helen

[tinkerbell]

Most insurance companies will not cover cross gender hormone therapy if your birth sex is still on their records.....I know.... totally crazy, huh?


tinkerbell

[Melissa]

I haven't had insurance for the past few months and have been paying out of pocket as well.  However, when my insurance becomes active in August, I'll be on it as female.

Melissa