Susan's Place Transgender Resources

Im going to see dr. hammel in houston for HRT once i get a therapist letter. Im not sure if my insurance will cover estro and sprio but i found that generic estro is on the 4 dollar list at walmart. Im just trying too see if this is actually true or if hormones cost abit more.

There are many factors in the price from the delivery method to whether it's a brand or generic to where you take your script. Once you have the script you will be able to see what if anything your insurance covers. You might get lucky and they cover it. Good luck and Hugs
Mariah

Yes it's on the $4 list for 30 pills of either dosage. If you need 90 pills it's $10. I get mine from there.

If you go to a regular pharmacy like Walgreens it's $40+

There really isn't much variation of the generic sold in the U.S., most pharmacies seem to carry the same blue and green pills made by Teva.

Some insurances will cover it but some will require pre auth. Others like mine will say you're male you're not supposed to be taking this. Technically I can force them because NY State is supposed to cover trans care but I haven't bothered since the difference in copay is like $5. Besides when I change my docs to female it will be covered.

Awesomeeee. does the 4 dollar script apply to everyone or is there a requirement?

Quote from: taylorhbic on May 30, 2015, 12:33:47 PM
Awesomeeee. does the 4 dollar script apply to everyone or is there a requirement?

Everyone.

Bear in mind that target and I believe Costco have the same generic drug program (for those who have problems with shopping at Walmart for whatever reason). Costco does not require a membership for pharmacy purchases. I believe that is federal law.

im gonna go to walmart when im prescribed lol and save money. People told me they where really expensive, im glad i asked someone.

Yep all I'm saying is that target and Costco also have $4 prescriptions too so you have a choice.

Just be careful the bottle they (Walmart) put it in tends to break the pills if you shake them up.

Like others have said the pricing depends on many factors such as brand vs generics and copay, etc. The coverage will also depend on your insurance policy. It's best to call your insurance and ask these questions directly. Also ask them to send you their forumulary because it lists things like if there are quantity limits or gender requirements.

They said they cover the scrip but their policy is transgender hormones and surgery are just cosmetic.

I am so happy that I clicked on this thread. To date I have been using Walgreen's pharmacy, however I have no qualms about using Walmart.

Melitta

How much does spiro cost?

Quote from: rachel89 on May 30, 2015, 03:30:16 PM
How much does spiro cost?

I have to check but only a small dose (about 1/8 to 1/4 of what MTFs get) is on the $4 list. My insurance has to cover it and it's a $5 copay. This means it will cost at least $5 out of pocket. I think for my dose it's about $20 out of pocket. My dose is about half of what many MTFs take, as my T did not need as much suppression.  (It was already low)

However if you call them they may be able to tell you the out of pocket (cash) price even without a prescription. I've found my local Walmart pharmacy to be extremely friendly and accommodating. They don't misgender me even when I show a male ID and present female or androgynous female.

It is worth noting that even if you're a "male" on your insurance spironolactone will be covered as a blood pressure medication. In fact that is what I also use it for.

Quote from: .Christy on May 30, 2015, 02:22:50 PM
Like others have said the pricing depends on many factors such as brand vs generics and copay, etc. The coverage will also depend on your insurance policy. It's best to call your insurance and ask these questions directly. Also ask them to send you their forumulary because it lists things like if there are quantity limits or gender requirements.

All well and good but it's helpful to find out out of pocket costs since a lot of insurance is resistant to paying for "female" hormones for genetic males. In fact insurance from my workplace does not cover any sort of bio identical hormone replacement therapy at all. Not even for menopausal cis women. However they may have to cover for trans women since the NY governor says they have to cover trans care.

Also not everyone has insurance.

The other thing to keep in mind is that some LGBT community health center clinics such as Callen-Lorde in NYC have the hormones at reduced cost, funded through donations. They do this because they are a non profit.

As far as brand vs generic in the USA most doctors will prescribe just generic "estradiol."

So it's good to know options.

how much does a dose appropriate for most pre-op trans women cost (as opposed to the cost of spiro for non-transsexual uses), and how does that compare to the cost cyproterone  acetate?


Mod Edit- HRT doses are not permitted. TOS 8

Sorry about the rule violation  I hope its appropriate to discuss cost.


Mod Edit - The Missouri reference was not appropriate and verged on a TOS 2 and 5.

Thank you for the apology and cost is just fine we just can't have doses mentioned. Thanks
Mariah

Quote from: rachel89 on May 30, 2015, 03:54:58 PM
how much does a dose appropriate for most pre-op trans women cost (as opposed to the cost of spiro for non-transsexual uses), and how does that compare to the cost cyproterone  acetate?


Mod Edit- HRT doses are not permitted. TOS 8

The small low dose is $4. I don't have info on the larger doses used my MTFs, sorry. I will call them and ask, but last I remember it wasn't all that much, about $20 for 30 day supply.

They have a list online you can look for Walmart generic $4 list in your favorite search engine.

Cyproterone acetate I'm not even sure is available as I believe it is not FDA approved.

I know we can't talk doses, so I don't know how much this will help, but I'm on my "maintenance doses" now and my Estradiol costs me about $8. Spironolactone costs about $25. And that's for a 45 day supply.

I pay $25 at CVS for a 90 day (180) pills supply of spiro. I have no insurance but they have codes they can use. I get 90 days of estradiol for about $13. I'm NOT on the lowest dose of E. It definitely pays to ask.

Quote from: Dee Marshall on May 30, 2015, 11:14:59 PM
I pay $25 at CVS for a 90 day (180) pills supply of spiro. I have no insurance but they have codes they can use. I get 90 days of estradiol for about $13. I'm NOT on the lowest dose of E. It definitely pays to ask.

That's true. There are also discount cards.

I thought the cost of HRT was a lot more expensive, like over $100 a month.

I called my local walmart (I had to call for a refill of one of mine anyway) and without insurance it's $27.38 for 30 day and $76.90 for 90 day. This is for my dose. Most people are prescribed twice that, so simply double the price since this is the largest dosage they carry.

Now if your doctor wants to save you some money, I am guessing they can just prescribe 4x the smaller pills as they are on the generic $4 list. But if you have insurance it is usually covered as blood pressure medication, as I had mentioned previously.

This pricing is without insurance. There is no sales tax in NJ on prescription drugs, so the price may be slightly different in your state.

So it's not on the $4 list but it's not horribly expensive either.

Quote from: rachel89 on May 31, 2015, 09:07:38 AM
I thought the cost of HRT was a lot more expensive, like over $100 a month.

It can be.

Estradiol from Walgreens was $40+ for me when I got my first scrip filled. Silly me just chose the pharmacy closest to work. Then I discovered the Wal-Mart $4 list.

Some of these pharmacies really inflate the cost. For example, Rite-Aid wanted to charge me $80 for metformin (diabetes medication). Walgreen's had it for $40. Wal-Mart had it for $4 without insurance and my insurance has a mail order pharmacy that will charge me only $2. From what I understand even with the $4 prescriptions they aren't losing money.

So it pays to shop around.

Also, the prices you see at online pharmacies are often more than the list price for generics at the US pharmacies because they (online pharma) often sell the name brand and not the generic. Just on cost alone if you can see a doctor and get a prescription there is no reason to be ordering online. Of course if you can't, then you might not be left with much of a choice.

Well i know that my insurance (blue advantage silver) wont cover hrt. they said this stuff is cosmetic, but would there be a way around that? i dont mind paying 4 dollars for estro, but i think spiro is whats expensive.

Quote from: taylorhbic on May 31, 2015, 06:37:09 PM
Well i know that my insurance (blue advantage silver) wont cover hrt. they said this stuff is cosmetic, but would there be a way around that? i dont mind paying 4 dollars for estro, but i think spiro is whats expensive.

Yes. Spiro is covered as blood pressure medication by most insurances.

Does anyone think my blood work will be covered by my insurance? all they said was that trans related stuff isnt covered but no where in my blood does it say that.

Always best to ask them directly. Do you have access to what is included in your plan. It may say what is covered in regards to what. Hugs
Mariah

The problem is that the doc im gonna go see denied the out of network refferal like 5 times even though my insurance company said they couldnt do that, i called my insurance back and they said that they can. So i guess it depends who i ask which is why its taken so long for me to do all this. I need too ask if they will cover bloodwork even though im seeing her out of pocket. I hope this works out ive been trying to do this a long time

Quote from: taylorhbic on May 31, 2015, 08:05:07 PM
The problem is that the doc im gonna go see denied the out of network refferal like 5 times even though my insurance company said they couldnt do that, i called my insurance back and they said that they can. So i guess it depends who i ask which is why its taken so long for me to do all this. I need too ask if they will cover bloodwork even though im seeing her out of pocket. I hope this works out ive been trying to do this a long time

I went to Dr. Hammel for almost 5 months. He doesn't accept any Insurance for Transgender patients that I know of. As he said that most insurance deny it anyways.

I just did all my bloodwork out of pocket, till I moved to my current Endo who fully accepts my insurance(Cigna)

You can get it covered by insurance if you do it right. Get a doctor who does primary care along with hormones and they can bill the insurance for a primary care visit and not any sort of trans care. The exclusions are stupid because they run the same tests anyway except for the hormone levels and even so as a genetic male testosterone test will be covered. Insurance usually does not care and you aren't gaming the system because the whole purpose of the doctor visit is to assess your general health anyway. Prescribing the hormones is just a small part of it.

All of my visits are covered, minus the usual $15 copay. Once they do the billing codes correct insurance does pay without complaint.

Btw for Walmart you can view the $4 list from the app

(https://www.susans.org/proxy.php?request=http%3A%2F%2Fi1188.photobucket.com%2Falbums%2Fz403%2Frjairam%2F1AE6DF9C-8C9F-459D-B75A-4CFD711FA65D_zpsrtb21xkk.png&hash=5d655fafbca28055e8bfb6ad1455a01a2d7defc7) (http://s1188.photobucket.com/user/rjairam/media/1AE6DF9C-8C9F-459D-B75A-4CFD711FA65D_zpsrtb21xkk.png.html)

Quote from: taylorhbic on May 31, 2015, 08:05:07 PM
The problem is that the doc im gonna go see denied the out of network refferal like 5 times even though my insurance company said they couldnt do that, i called my insurance back and they said that they can. So i guess it depends who i ask which is why its taken so long for me to do all this. I need too ask if they will cover bloodwork even though im seeing her out of pocket. I hope this works out ive been trying to do this a long time

Find another doc unless you're in love with this one.

Worse come to worse save your receipts and file a claim with your insurance to get reimbursed.

i wish i knew exactly how too do this. I called my insurance company earlier and they said that i would have to pay out of pocket for blood word even if the refferal was ever approved.

If you're not covered by insurance, you should shop around all services and prescriptions. There is a very wide variation of pricing for prescription medications. Also, the discount cards can provide additional savings. Not intended as a slam, but my experience is that Walgreen's has some of the highest pricing. YMMV

-AshleyP

Quote from: taylorhbic on June 01, 2015, 06:42:26 PM
i wish i knew exactly how too do this. I called my insurance company earlier and they said that i would have to pay out of pocket for blood word even if the refferal was ever approved.

Your doctor just has to use the right billing codes and you find one that does your HRT appointments as a primary care visit (which in reality it should be)

here is an odd one i just came across tonight. i believe it is billing code 45 that signals in the computer for transgender issues.  supposedly items like female hormones are automatically rejected if you are coded as male in the system.  this will automatically fix it or send an alert to someone in the company do they can address it for you. 
i always thought the codes were 3 digits, so it could be the wrong code they quoted in the txt, but all codes are the same in the insurance business im guessing.  i found this code under googling "medicare for transgender"..    good luck and let us know if anyone tries this and how it works;)

im not worried about the cost of hormones at this point, im just worried about blood work. There isnt a doc i can see in network that does hormones meaning i cant have them as a primary.

 Also is it possible to get lab work done elsewhere and have it sent too the doctor?

Quote from: taylorhbic on June 02, 2015, 07:08:55 AM
im not worried about the cost of hormones at this point, im just worried about blood work. There isnt a doc i can see in network that does hormones meaning i cant have them as a primary.

Goto your primary care dr.  Tell them flat out you are on hormones.   Tell them the insurance will not pay for the labs unless thry do it.  Most primary doctors will figure a way to get you in.  Plus, you need to tell your primary if you are on hormones.   Its not their choice, but their duty to help you;)

This is related to HRT cost, but what are reasonable costs to for tests and getting the prescription in the first place. I will probably be going to Howard Brown for their THINC (Trans Hormone INformed Consent program)  because they are reputable and less than 3 hours away depending on traffic.

Quote from: taylorhbic on June 02, 2015, 12:32:53 PM
Also is it possible to get lab work done elsewhere and have it sent too the doctor?

Yes.

Let them give you a lab order on a prescription blank or another form used for lab orders. Then go to the lab of your choice and they will send it to your doctor.

If you have insurance, talk to your insurance and see if they have a preferred in network lab. In my case it's quest.

Quote from: rachel89 on June 20, 2015, 12:22:05 AM
This is related to HRT cost, but what are reasonable costs to for tests and getting the prescription in the first place. I will probably be going to Howard Brown for their THINC (Trans Hormone INformed Consent program)  because they are reputable and less than 3 hours away depending on traffic.

Without insurance maybe about 500-600. My doctor billed over 800 for my first visit though but I have insurance and it was covered. Bear in mind that a lot of these places bill sliding scale and you probably won't have to pay the full amount.

I'm looking a doing the tests locally and then taking the results to THINC to make the process go faster with fewer visits to Chicago.