Testosterone gel - insurance won't pay

Posted by vincescs @vincescs, Apr 13 6:54am

I've been on testosterone replacement therapy using generic AndroGel for many years due to low testosterone (aka testicular hypogonadism). Getting my testosterone level up into the 500 - 600 ng/dL range has made a big improvement in my overall mood, energy level, and sex drive.

Now, after a job change and enrollment in new benefits, insurance is refusing to approve payment for generic AndroGel stating that they don't cover age-related hypogonadism. So, the insurance company has essentially attributed my low T to age (I'm 58) in order to change my diagnosis and deny payment.

The out-of-pocket cost for generic AndroGel without insurance is very high, so I may need to consider switching to lower-cost testosterone injections to manage my testosterone level. Has anyone here made the switch from gel to injections? Which form are you using (e.g., cypionate, enanthate)? Are you injecting yourself at home or receiving injections from a healthcare provider? Are you happy with the results or are you experiencing peaks and valleys?

Thanks in advance for any info you can share.

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celia16 | @celia16 | Apr 13 9:06am

This is outrageous. Have you explored appealing or figuring a way to get coverage? It seems so unfair,

vincescs | @vincescs | Apr 13 9:14am

In reply to @celia16 "This is outrageous. Have you explored appealing or figuring a way to get coverage? It seems..." + (show)

I will work with my doctor to appeal but am not optimistic, so will need a backup plan. I'm sure the insurance company will point to FDA drug safety communications, but this is clearly an attempt to limit costs.

fortunateoldman | @fortunateoldman | Apr 23 2:42pm

Assuming you live in the U.S., you can obtain a GoodRx prescription drug card for free and obtain generic AndroGel 1.62% for as low as $41 per month copayment for 2 pumps per day depending what pharmacy you choose.

GoodRx does require a prescription but there is no approval and denial process involved.

I used testosterone gel for years until it completely distorted my blood count. It caused a dangerously high RBC, hematocrit and hemoglobin count. It also depleted my iron stores too. Be careful as it can set you up for some severe health issues if your doctor doesn’t perform a CBC and testosterone level at least every 6 months.

vincescs | @vincescs | Apr 23 4:05pm

In reply to @fortunateoldman "Assuming you live in the U.S., you can obtain a GoodRx prescription drug card for free..." + (show)

Thanks - yes, I have a GoodRx card and have priced out my copay using that approach. I'm at 3 pumps per day so it's a more expensive than your estimate. Using GoodRx I'll essentially be paying per month what I had been paying for a 3-month supply using CVS Caremark with my previous employer. I don't have any cardiac risk factors, but I get all blood work needed between my urologist and my cardiologist.