Starting Menopause HRT: What you need to know about insurance and access
- Peggy Bronson
- 11 minutes ago
- 6 min read
Starting Menopause HRT can feel daunting, specifically if your GYN isn't on board and you are navigating the start of your journey alone. But, you are not alone, you have me and my six years of experience.
I've become a patient of Midi Health, Winona, Alloy, MyMenopauseRx and Joi Women's Wellness all for the sake of science and this website. Some accept medical and prescription insurance and some do not. All of these companies are online, telehealth providers, which is my preferred way to get HRT. If bloodwork is required, many of them have partner relationships with Quest or Labcorp. Be sure to visit my various blogs on what I paid out of pocket with each.
Is HRT covered by Insurance
Here is the thing, some Hormone Replacement Therapy is covered by medical and prescription insurance and some is not. Some of the online providers accept insurance and others do not. Let this blog be your guide on where to start based on your needs.
Let's start with, "Will my medical insurance cover an HRT Appointment?" The answer is yes. If you choose a doctor or practice that specializes in HRT and you confirm they take your medical insurance, then you can use your insurance. Keep in mind any co-pays or deductibles you may have would still need to be paid out of pocket. The online provider I would recommend if you want to use your medical insurance would be MyMenopauseRx.
They have a physical location in Illinois and also offer 20-minute telehealth visits. They also offer a $99 self-pay discount for the 20-minute visit if you don't have insurance or for some reason opt to not use insurance. They are very familiar with which HRT, the formulations and dosages that are covered by prescription insurance. If you want or need bloodwork, they have options for that as well. Midi Health is similar in the way they practice, except their 30-minute visit is $250 and again your out of pocket will be based on your insurance, co pays and deductibles.
Does prescription insurance cover medications
The companies that specialize in HRT understand that some medications, their formulations and their dosages have been approved by the FDA, meaning they are covered by prescription insurance. If you visit a doc who understands that the meds/ingredients need to be FDA approved, plus a formulation that has been FDA approved and a dosage that has been FDA approved, then you shouldn't have any issues with your prescription insurance covering a portion of the meds.
When I used my prescription insurance with both Midi Health and MyMenopauseRx I picked up my meds at my local CVS and used either my prescription insurance or a GoodRx Coupon.
The cost of my Estradiol patches over the year ranged from $10 - $30 per month. The cost of the progesterone tablets was also about $10 - $30 per month. The difference in cost has something to do with how pharmacies price their meds, which I don't clearly understand. There was one time that using a GoodRx Coupon was a better deal than using the prescription insurance my full time employer provides, so check that out as well. Here is my full blog on that experience.
How to start Hormone Replacement Therapy
The first step is finding a provider who offers online, telehealth HRT. See list of preferred providers here. All of these online providers specialize in Hormone Replacement Therapy for Menopause.
MyMenopauseRx accepts medical and prescription insurance. They offer 20- minute consultations. They will write your prescriptions and send directly to the pharmacy of your choice. Joi Women's Well will not accept insurance for Bloodword or appointments, but does offer to write prescriptions than can be picked up at your local pharmacy. Joi requires bloodwork upfront, the cost of which also includes your first consultation to get the process started. You can use the code BRONSON for 10% off your bloodwork.
Alloy and Winona don't require an appointment, rather, once you create an account you begin to have a text communication/conversation via their patient portal. Once you and your doc land on which prescriptions are right for you, they will send to their partner pharmacy and ship directly to your home. You never have to leave the comfort of your home for an appointment or to pick up meds. Winona doesn't charge a fee to create an account, Alloy does charge approximately $50 to create an account and to get started.
Get 10% off first order of Winona here - WINONA
Get $10 off first order of Alloy here - ALLOY
How much does HRT cost per month
The cost of Hormone Replacement Therapy can range from about $20 per month to $85+ on the higher end. The cost will depend on the HRT formulation are prescribed, for example, the estradiol patch is more pricey than a pill.
It will also depend on whether you doc is prescribing meds that are FDA approved and can be picked up at a pharmacy. Also, if they are prescribing a custom formulation and/or a custom dose, those can be a bit more expensive as they are individually produced unlike the formulations you get at a pharmacy that can be mass produced by a pharmaceutical factory.
Bioidentical Hormones Pros and Cons
What is the difference between HRT and BHRT
The term, Bioidentical Hormones actually refers to the ingredients the medication is made of. Any HRT medication that is made of Estradiol or Progesterone is considered bioidentical. It may come from your local pharmacy or it may come from a compound pharmacy. It's the ingredients that qualifies a medication as synthetic or bioidentical. Estradiol, regardless of whether it's a patch or a pill, comes from a local pharmacy or from a compound pharmacy is technically bioidentical.
Compounding pharmacies step in when a medication needs to be custom created. So for example, if you doctor wants to prescribe estradiol in the troche formulation (pill that melts under your tongue) or in a custom dose, your local pharmacy can't custom create the medication, so it would be ordered through a compound pharmacy. Many docs and companies that prescribe HRT have relationships with compounding pharmacies and will sometimes order your meds from there, if they feel it is warranted.
Starting Menopause HRT What you need to know about insurance and access
When I first started HRT, because my doc choose to put me on a troche pill in a custom dose that included estradiol and progesterone combined, it couldn't be fulfilled at a local pharmacy. I made the assumption, only because I didn't know any better that bioidentical wasn't covered by insurance, but it was actually due to the custom formulation and custom dose that caused it to not be covered by my insurance.
Once I found a practice and an online doc who knew which bioidentical formulations and dosages are approved by the FDA, it was then I was able to begin using my prescription insurance or a GoodRx coupon code to help off set my prescription costs.
HRT medications whether from a traditional pharmacy or a compound are both great and can help alleviate those pesky menopause symptoms. Don't discount either as there is a place for all formulations and dosages depending on your needs.
When shopping for an HRT provider you want to consider, do you want an online/telehealth provider or do you want to see a doc in person? You want to determine if you want to utilize your medical and prescription insurance. If you don't have insurance, then you need to find a provider who doesn't require/take insurance as they'll have the best pricing if you are paying out of pocket.
The best provider in my opinion, if you want to use insurance is MyMenopauseRX and if you are looking to pay out of pocket with no insurance then check out Winona or Alloy. If you know you want to start the process with bloodwork, and I'm all for bloodwork, but not everyone is, then check out Joi Women's Wellness. They offer several blood work packages. Each blood work package includes your first 30-minute consultation to review the results of your bloodwork. They don't accept insurance for the blood work or the initial consult, so that will be out of pocket. But after the consultation, you can request that the prescriptions be sent to your local pharmacy where you can use your insurance or they also have partnerships with compound pharmacies where the meds wouldn't be covered, but sent directly to your home after payment.
If you have any questions, you can email me at peggyb@hormonetherapyhub.com.
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