Does Medical and Prescription Insurance cover Hormone Replacement Therapy
I've been on HRT since December of 2019. The first doc to put me on HRT told me that it wouldn't be covered by my insurance. I believed him. What I didn't understand at the time, is that some formulations of Hormone Replacement Therapy are covered by insurance, and some are not.
Any formulation and dosage that has been approved by the FDA will be covered under your Medical and Prescription Insurance. If you are being prescribed a formulation or dosage that hasn't been approved by the FDA, then your insurance will not cover the HRT.
The reason my HRT wasn't covered when prescribed by my weight loss Doc in 2019 is because it was a troche (pill) that came in a dosage that wasn't approved by the FDA. The main ingredient estradiol was approved by the FDA, but because the dosage he has prescribed was customized specifically for me, that meant it wasn't covered. I was brainwashed into thinking that the customized dose was more important than anything else and so I continued to pay out of pocket. Looking back, I just didn't have enough information. Customized doses sound modern and better than a standard dose doesn't it, but that really isn't the case with HRT. There are many variations of formulations and dosages available that have been approved by the FDA.
Best HRT with Insurance
The best HRT with Insurance is a Hormone Replacement Doctor or facility that takes Medical Insurance and is informed when it comes to the formulations and dosages that are approved by the FDA.
Obviously, most doctor's offices take insurance, but not all doctors are comfortable prescribing HRT and some are not aware of which formations and dosages are approved by the FDA, therefore covered by insurance.
In my opinion, the best online HRT provider is MyMenoopauseRX. They accept a wide variety of insurances and are very well informed around what HRT medications that your prescription insurance will cover.
Best HRT without Insurance
If you don't have insurance or if for whatever reason you don't want to get your insurance company involved with your Hormone Replacement Therapy, then the companies, I can recommend based on my personal experience is Winona and Alloy.
Neither of these two companies require an in-person telemedicine visit which means you won't need to take time out of your day. For both of these two providers, you'll create an account and then all of the communication between you and the HRT doctor or specialist who is assigned to you will be via their patient portal through text communication. You'll have unlimited opportunity to ask as many questions as you want. Once the two of you land on what your therapy will be and you've paid for them in full, they'll send the prescriptions to their partner pharmacy and the meds will be shipped directly to your home.
Hormone Replacement Therapy Pricing with Insurance
If you have medical and prescription insurance and plan to use it, here is what you can expect. You should expect an initial consultation visit and possibly follow-up visits plus then the cost of the HRT meds.
The doctor visit and the cost of it will depend on several factors. First, is your insurance accepted and considered in-network with the doctor or facility that you plan to visit? You'll also have to take into consideration where you are where your annual deductible and any co-pays your insurance may require.
The first time I used my medical insurance to pay for a doctor visit, I learned that my insurance was considered out-of-network. If I chose to move forward, the cost of the appointment would go toward my out-of-network deductible, which meant I would be paying out of pocket. I did, however, use my HSA credit card.
Midi Health, accepts insurance and charges $250 for the initial consultation fee and then $120 for follow-up visits thereafter. Whether your insurance coverage pays for all or some of the visits is dependent on the items noted above.
MyMenopauseRx offers a self-pay option if you learn that your medical insurance is out-of-network or if you don't have insurance. The self-pay option discounts the initial consultation down to $99, substantially less than Midi Health's $250 for the initial consultation.
As a reference point, I'm currently on a .0375 estradiol patch and 200 mg progesterone tablet. The first 3-month supply I picked up I used by Express Scripts prescription insurance provided by my full-time employer, and it came out to $69.38 per month for the patch and pills, excluding the consultation visits. The next time I picked up my 3-month prescriptions I used a GoodRx coupon and my cost per month was $33.58. Who knew using a GoodRx coupon would be even less than using my prescription insurance!
Once you add in the consultation visit(s) plus the cost of the meds, you are looking at $84.41 per month if you average out four visits per year plus the cost of the meds.
Hormone Replacement Therapy Pricing without Insurance
If you choose to the go the route where you don't use insurance for whatever reason, the good news is that the companies who cater to you are able to disclose and publish their pricing for start-up costs and medications they prescribe.
The two best providers in this arena are Winona and Alloy. They offer many of the same products but do vary a bit on the pricing. There are four pretty common HRT products that both companies offer in three-month supply quantities:
Estrogen Pill/3 Mos $119
Estrogen Gel/Cream/3 Mos $209
Estrogen Patch/3 Mos $224
Progesterone $Free with Estrogen Rx
Fee to create account $49 (one-time fee)
Estrogen Pills/3 Mos $137.70 (15% off - create new account using link above)
Estrogen Gel/Cream/3 Mos $226.95 (15% off - create new account using link above)
Estrogen Patch/3 Mos $379.95 (15% off - create new account using link above)
Progesterone The Estrogen/Progesterone cream combo is the same price, as estrogen alone, so no additional cost for progesterone.
Fee to create account $0
Winona doesn't charge a start-up fee, Alloy does. These two companies are very similar in almost every facet that you can compare them. The only real differentiator is the cost of the estradiol patch one compared to the other and the fact that you need to pay $49 to start an account with Alloy. Once you apply the 15% off with Winona the cream formulations are a just a bit more than the cost of Alloy even with the $10 off coupon code.
Hormone Replacement Therapy - Insurance or No Insurance, which way to go?
The biggest difference with whether you go one way, or the other is really the consultation. If you have lots of questions and want 20 to 30 minutes with an HRT specialist to talk through your symptoms, what you should expect and any concerns you may have, then going down the path with a company who affords you the time with a real doc is probably a good option for you. You can expect it to cost you about $84 per month on average including visits and meds.
However, if you don't feel the need to have a live one on one consultation and visit with an HRT specialist and want to save yourself some money, then going with a provider who doesn't accept or take insurance will save you a few bucks per month. Alloy's patch is $74.66 per month and the progesterone is free, Winona's estrogen/progesterone cream is $75.65 per month.
The difference is literally about $10 per month savings to go the no insurance route, however you are giving up your personalized initial consultation and your ability to meet with a doctor. Only you can decide with option is the best for you.