Just wanted to post this here since I experienced a minor/frustrating hurdle yesterday when seeking estradiol IM (i.e., for injections, NOT the pill form).

For some specialty prescriptions, and here I'm specifically referring to estradiol vials, an insurance company will want you to use mail-order. This means your provider will send the prescription to the company they're linked with that will then set up an account (if you're new). It is then shipped to your place or to the provider's office. I chose the former since my PCP asked me to take it to my next visit when I'll be initiating HRT.

I decided to post this since I was on the phone for a couple of hours yesterday and kept getting sent to different people and outing myself as trans to strangers. I was finally told to do the following: call my insurance's pharmacy contact number and ask them to transfer me to or give me the contact information for the company they use for "medical necessity/medical specialty."

It really did seem too good to be true when my prescription was sent to a retail pharmacy in my neighborhood, lol. Of course, when I asked them to fill it, they told me it wasn't covered, which sent me into panic.

Hope your insurance doesn't suck like mine does. And I do want to recognize that it's a privilege to have medical insurance in the States to begin with, and that I'm grateful mine will cover the estradiol. I guess I'm having a hard time understanding why I can't get it at my pharmacy.


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Ouch. My insurance sends me a letter every quarter recommending their mail order pharmacy... so far I have ignored them and used the one across the street. They are so great, I just don't want to switch...

Maybe I was just lucky that they still covered everything...

The Army still covers mine.  So far they're still ignoring Trump.


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My insurance covers EV and it is sent to me by their mail order pharmacy company Express Scripts.  I get 3 vials of the 5 ml 40 mg/ml strength every three months for $10.  For some reason the insurance company wants me to throw away the vial after two injections which is why they send 3 vials at a time.  I find it convenient, cheap and easy to do.   Good luck.

Quote from: I Am Jess on November 07, 2017, 06:02:28 PM
My insurance covers EV and it is sent to me by their mail order pharmacy company Express Scripts.  I get 3 vials of the 5 ml 40 mg/ml strength every three months for $10.  For some reason the insurance company wants me to throw away the vial after two injections which is why they send 3 vials at a time.  I find it convenient, cheap and easy to do.   Good luck.

Mine will be through Express Scripts as well. I now realize that I was - and maybe still am - frustrated that I have to wait another week or so to start. Haha.  I knew I wanted to start, but the delay has made me realize I want it even more. Once I'm all set up with Express Scripts, I'm sure my complaining will go away.

Also, I'm happy to hear others can get their EV vials at their local pharmacies! With all the different types of health insurance and access to them, it's can be hard to know how this process will look on that end.




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Quote from: antia212 on November 07, 2017, 03:36:38 PM
I guess I'm having a hard time understanding why I can't get it at my pharmacy.

In the medical insurance world, this is called a preferred provider. Local retail pharmacies are at the mercy of 3rd party payers (medical insurance companies). Some are very good and others are worthless. Most all insurance companies contract for various services at reduced rates with many providers ( doctors, hospitals and pharmacies). This is a standard way of controlling costs.

Express Scripts is one of the largest mail order pharmacies in the US. They are very good at what they do. That is, provide maintenance medications for millions of people at a very low cost. The disadvantage is the wait time to get medications, so you have to order ahead of time and you may have theft from your mailbox, if it is unsecured. Because of these problems, insurance companies will allow some prescriptions to be filled at a local pharmacy for immediate needs. You have to call your insurance company to get approval for a local refill of your medication.

Quote from: Dani on November 08, 2017, 03:49:15 AM
In the medical insurance world, this is called a preferred provider. Local retail pharmacies are at the mercy of 3rd party payers (medical insurance companies). Some are very good and others are worthless. Most all insurance companies contract for various services at reduced rates with many providers ( doctors, hospitals and pharmacies). This is a standard way of controlling costs.

Express Scripts is one of the largest mail order pharmacies in the US. They are very good at what they do. That is, provide maintenance medications for millions of people at a very low cost. The disadvantage is the wait time to get medications, so you have to order ahead of time and you may have theft from your mailbox, if it is unsecured. Because of these problems, insurance companies will allow some prescriptions to be filled at a local pharmacy for immediate needs. You have to call your insurance company to get approval for a local refill of your medication.

Thanks for the heads up, Dani. My first vials will be shipped on Friday, though I am concerned about theft. Someone in my building tends to open packages left in the hall way, unfortunately. Either it's time to complain to the super or I'll ask if they can ship them to a pharmacy/my provider



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Just a thought on the theft issue, often times you can have the package redirected to a local retail location to pick up. I do this a lot with UPS and FedEx for things I either don't want stolen or don't want curious eyes to see. I'm not sure if usps can do this but I'm sure the pharmacy can ship to another location like your work or a post office. Just something to think about [emoji4]

It's been three weeks since I got my prescription and it will *finally* ship to my doctor's office on Monday. I have an appointment on Thursday to learn how to give myself the shots. Finally! 

My insurance is crap and made this process long and difficult for no reason. It took a woman named Stephanie at the mail order pharmacy to call my insurance herself and take it up to escalation for them to finally realize that it is covered. Apparently, I didn't even need prior authorization from my pcp. They just didn't want to do it? Ugh.

I will have been on Spiro for four weeks when I get my first shot. I'm so excited.


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