Testosterone Replacement Therapy (TRT) and Insurance

If your doctor has suggested you go on TRT then there are some things you should know about insurance issues before you make the decision.   I have learned a lot about TRT in a short time.  If you want to see the problems with the health care system in America this is a great example of how screwed up it is.

TRT is covered by insurance, right?

On paper, certainly.  In real life, good luck.  I am covered by some of the best medical insurance available in America and so I naively assumed that getting TRT covered would be easy.  The truth is that even with awesome medical coverage there is often a very high deductible if you can get the insurance to cover the TRT at all.  Its not just a matter of the doctor deciding what is best for the patient’s health – that is easy part.  The hard part is navigating the insurance companies paperwork jungle to get it approved and because the best TRT treatment (gels) are very expensive, they drag their feet every inch of the way with ridiculous unwritten procedures and 800 numbers staffed by people who know nothing.  If you are put on TRT, you quickly learn what the term  “pre-authorization” means.  Before the medication is covered and every 12 months afterward, it must be pre-authorized.  The yearly re-authorization seems a bit silly considering that there are no documented cases of people recovering from hypogonadism.  In a very short time I have come to absolutely dread this yearly “pre-authorization” because every time so far it has required a minimum of three very stressful calls to the insurance company and three calls to the doctors office to get it sorted out.  Once I even had to do a conference call with the insurance and my doctor who literally had to scream at the insurance rep because they were being so ridiculous with their demands.  What I have figured out is that:

The goal of medical insurance companies in America is to deny/delay expensive claims until you die, give up trying, or change coverage to another carrier.

Choices of TRT medications

This is what I was also very naive about.  When the TRT discussion happened with my doctor, he presented the gel as the best and explained why (see all about TRT) – TLDR because it mimics the daily testosterone variations of a healthy individual nearly perfect without frenetic highs or depressing lows involved with injections every two weeks.  Of course I want the best, why wouldn’t I?  I will tell you why you might not want the best, because of the STRESS involved in fighting with your damn insurance company constantly. We all have too much stress in our lives and having to put a month long battle on the calendar for every January takes its toll on quality of life.  Now I am starting to see the value of the much cheaper and “inferior” types of trt – the injectable version.

Shocking TRT cost comparison

When I asked my doctor about cheaper options for TRT, I was surprised that he had no idea how much they cost so I had him write down the two options and I went to my local Walgreens to get prices so I could make an informed decision. This is a perfect example of why the US health care system is so screwed up – patients do not understand the costs nor do doctors.  We cant make good decisions without information.  I did a cost comparison at my local pharmacy and was totally shocked.  I asked for the cash price, meaning they dont even put in your insurance info so there is no special contracted rate – the cash price.  Here it is in black and white so you can see how much these two common TRT options cost.  Of course, what your doctor prescribes will probably be a different amount than the typical below but it gives you a cost comparison for the typical case:

Name typical dose typical frequency $/dose $/mo method
testosterone gel 1% 4 pumps daily $15 $458 topical
testosterone cypionate 200mg/ml 200mg every 2 weeks $12 $24 injection

Note that these were the prices on February 13, 2020:

testosterone-cyp-200mg-10

testosterone-gel-1pct-generic

TRT gel vs cheaper options

So, TRT gel is the best for your health because the testosterone levels mimic what occurs in normal makes BUT it adds a lot of stress and high co-pays.   The injectable testosterone cypionate is definitely not as good for your health or to keep your mental state on an even keel because it puts your test levels too high for the first few days then a big trough the last week and it also adds the problem of injecting yourself or having someone else do it.   Its a tough call which is “best” so if you are on the gel TRT and are being driven crazy by the ridiculous foot dragging of the insurance company then take this info to your doctor and investigate this cheaper alternative.   As an aside, I discovered that my co-pay for the gel is WAY higher than the full cash, non-insurance price of injectable version.   I personally have decided that its not worth any more battles.  Its cheaper, easier, and lower stress NOT to use insurance for TRT.   Another case of insurance companies dictating treatment instead of doctors.  The next time, the insurance pre-auth gets denied I am going to give up and just pay cash for the cheaper TRT.  My time is valuable and I dont want stress in my life, to me “inferior” is superior in the big picture.

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