Susan's Place Transgender Resources

I got curious about the cost of estrogel so I did a google search and found that it was about $98 at Walmart but my cost with prescription at the pharmacy was $55 which I think is my copay.  The spiro was dirt cheap and way less than my copay but it looks like the estrogel was covered.  Does anyone else use estrogel?  If so is it covered by your insurance?  I'm just curious because $55 is a lot better than $98.

Quote from: Amy1988 on May 26, 2014, 04:21:08 PM
I got curious about the cost of estrogel so I did a google search and found that it was about $98 at Walmart but my cost with prescription at the pharmacy was $55 which I think is my copay.  The spiro was dirt cheap and way less than my copay but it looks like the estrogel was covered.  Does anyone else use estrogel?  If so is it covered by your insurance?  I'm just curious because $55 is a lot better than $98.

None of my female medications are covered by insurance, and they never have been on the three different plans I've been on since starting HRT. I'd see if you can get your prescription at Walgreens. They have a savings club thing that takes a chunk off of any medication. You can ask them to see how much would be taken off before you pay the $20 it costs for a year of membership. I know it makes my estradiol 1/4 the cost.

Quote from: Hideyoshi on May 26, 2014, 04:34:00 PM
None of my female medications are covered by insurance, and they never have been on the three different plans I've been on since starting HRT. I'd see if you can get your prescription at Walgreens. They have a savings club thing that takes a chunk off of any medication. You can ask them to see how much would be taken off before you pay the $20 it costs for a year of membership. I know it makes my estradiol 1/4 the cost.

I'll check that out, thanks but does anyone know if $98 for estrogel pump is non prescription price?

HRT should absolutely be covered by any insurance. There's no reason for it not to be. If for some reason it's not, call and talk with them. Talk with your physician and let them know you're experiencing difficulty securing insurance coverage for the HRT they're prescribing -- ask them to adjust their coding accordingly to allow you this coverage.

HRT, FFS, and SRS have all been agreed upon as being medically necessary. It's unfortunate that we have to put up with insurance companies and misinformed/apathetic physicians and surgeons denying us the rights to our healthcare.

Quote from: teeg on May 26, 2014, 06:04:13 PM
HRT should absolutely be covered by any insurance. There's no reason for it not to be. If for some reason it's not, call and talk with them. Talk with your physician and let them know you're experiencing difficulty securing insurance coverage for the HRT they're prescribing -- ask them to adjust their coding accordingly to allow you this coverage.

HRT, FFS, and SRS have all been agreed upon as being medically necessary. It's unfortunate that we have to put up with insurance companies and misinformed/apathetic physicians and surgeons denying us the rights to our healthcare.

Mine are denied by insurance but are so cheap on the walgreens savings club that it isn't worth it (for me at least) to fight their decision. They deny them because that medication (estrogen/progesterone) isn't normally prescribed to men. They do, however, cover the pills that are unisex, such as the spiro, and they cover the man's pill I take, which is finasteride. I didn't tell any of the insurance companies that I was transgendered, mainly because I didn't want to increase the cost (I was on my parent's plan for the first year of my HRT) for my parents by adding yet another 'pre-existing condition'

Depending how expensive the cream is on the walgreens thing, maybe a call from your doctor to the insurance company explaining the medical necessity of it is in order?

My endo gave me a estrogel discount card that lowers the price. I haven't tried to fill the script yet because she gave me like 3 months worth of samples. Which are about to run out. So I'll be trying before the end of this week and give an update of the card drops the price down. If it does you can ask your doc about that. Though I had read in the book that my insurance didn't cover hrt I still filled my scripts anyway. They never said anything or did anything regarding bills. So I am just going with it. We will see what happens when my insurance expires in 35 days.

Quote from: Hideyoshi on May 26, 2014, 06:25:26 PM
Mine are denied by insurance but are so cheap on the walgreens savings club that it isn't worth it (for me at least) to fight their decision. They deny them because that medication (estrogen/progesterone) isn't normally prescribed to men. They do, however, cover the pills that are unisex, such as the spiro, and they cover the man's pill I take, which is finasteride. I didn't tell any of the insurance companies that I was transgendered, mainly because I didn't want to increase the cost (I was on my parent's plan for the first year of my HRT) for my parents by adding yet another 'pre-existing condition'

Depending how expensive the cream is on the walgreens thing, maybe a call from your doctor to the insurance company explaining the medical necessity of it is in order?

Well it appears the estrogel was covered since I paid $55 but an online search reveals a range between $98 and $100 actual cost from all the well known pharmacies.  But I'm only assuming.

Sometimes insurance companies negotiate a lower price for the insured without actually covering the script. That may well be what happened with you.