Is Hormone Replacement Therapy covered by Insurance?

Your HRT could be covered by private insurance.

Will my Hormone Therapy be covered by insurance?

The best answer is; it depends. It depends on the type and formulation of Hormone Replacement Therapy you have been prescribed, and it also depends on the dosage of the HRT medication. Many HRT medications and dosages have been approved by the FDA, therefore would be covered by traditional prescription insurance. However, if your HRT specialist prescribes a formulation or disage that hasn't been approved, your prescription insurance will not cover the cost of the meds.

Bioidentical Hormone Replacement Therapy vs. Conventional Hormone Replacement Therapy

Bioidentical Hormone Replacement

Bioidentical hormones are lab-produced hormones derived from plants like yams and soy. They are chemically identical to those the human body produces. Estrogen, progesterone, and testosterone are among those most commonly replicated and used in treatment. Bioidentical hormones come in various forms, including:

• pills

• patches

• creams

• gels

• injections

Some bioidentical hormones are made by drug companies. Others, known as compounded bioidentical hormones, are custom made by a pharmacy, according to a doctor’s orders.

This pharmaceutical process is known as compounding. Compounding typically involves ingredients being combined or altered to meet the needs of an individual.

The U.S. Food and Drug Administration (FDA) has approved some forms of manufactured bioidentical hormones, including bioidentical estriol (a weak form of estrogen) and progesterone. However, the FDA hasn’t approved any custom-compounded bioidentical hormone dosages.

Conventional Hormone Replacement

HRT typically refers to the use of hormones to supplement or replace hormones that the body may not produce in sufficient quantities. Often used during menopause or in cases of hormonal deficiencies.  HRT can involve the use of synthetic hormones or hormones derived of animal sources. Formulations include:

• oral tablets

• transdermal patches

• topical creams & gels

• intramuscular injections

• vaginal products

​Many HRT formulations are FDA-approved and available in standardized doses.  

Common synthetic hormones used in HRT include conjugated equine estrogens and medroxyprogesterone acetate. HRT often uses standardized doses, and the ratios of hormones in these formulations may differ from the natural hormones in the human body.

A Note about Insurance Coverage

At this point, you might be thinking . . "I'd like to try Bioidentical Hormones, please." But before, you land on this as your final answer, let's continue the exploration of what your insurance company thinks of the two types of HRT.

When it comes to the more conventional hormone replacement therapies with their standardized doses and FDA approval, you'll find that many insurance companies with the right support and detail from your doctor will cover HRT. Some typical medications that are covered are:

• Estrogen (Estraderm, Premarin, Cenestin, Divigel and Climara)

• Progestin (Prometrium or Provera)

• Estrogen plus progestin (Prempro, Activella, Femhrt, and Climara Pro)

The ingredients used in Bioidentical Hormone Replacement Therapy are FDA approved, but the individualized compounding of those ingredients is not. What this means is that because the ratio of estrogen to progesterone your doctor prescribes specifically for you is compounded or created by a compounding pharmacy in lieu of a standardized dose, your insurance company may not cover it.

Some insurers draw the line between what they will and will not cover with regard to hormone replacement therapy based on whether the specific therapy is FDA approved.

Various types of FDA approved HRT are covered by insurance.

Is HRT covered by insurance?

The bottom line is that you should ask your HRT medical specialist if the medications they are recommending are covered by insurance, they should know.

If you are unsure whether you want to try conventional or bioidentical HRT, you may want to consider seeing a doctor at a clinic that offers both HRT types and accepts your insurance. This gives you the opportunity to consider both and make a decision after you have consulted with a professional and determined what is paid for by your insurance company.

However, I'm guessing many of us want to explore Bioidentical Hormone Replacement Therapy first, even though we realize it will cost us out of pocket. If the fact that BHRT is plant derived and can be customized in a dosage suitable for your specific needs versus conventional HRT that is animal derived, but in standardized dosing makes sense, then the expenditure you'll make in your purchase will feel like a smart investment in your overall health.

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