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Texas, United States


Insurance Companies Now Decide How Much Estrogen I Need?

I learn more and more each day just how the insurance companies are going to make Obamacare work and I'm not liking it.

 I'm a senior citizen on limited income and have been on a Medicare supplement for over 10 years and was happy with it. The co-pays were reasonable and so were generic prescriptions....but, they took a huge jump this year when Obamacare went into effect. I didn't mind paying a little more for specialists visits or diagnostic tests but I do mind what I found out this morning.

The mail order pharmacy my doctor recommended called with a recorded message saying my estrogen refill was denied by my insurance company for the second time my doctor sent it in and an explanation was being mailed. Well I didn't want to wait for the postman so I called my Medicare supplement I've been on ever since I went on Medicare.

I was prescribed estrogen almost 40 years ago by a little Jewish lady doctor who told me to stay on a low dose for good and don't let any "man" doctor tell me bones and body would thank me for it in my old age. She looked pretty darn good physically and mentally alert in her 70's so I obeyed her. Every time I changed doctors I told them the story and they prescribed it for me.

The last bone scan I had they told me I had the bones of a 25 year old...healthy. I silently thanked the old lady doctor. My "sexual" organs have remained in good working shape and I "occasionally" thanked the lady doctor for that satisfying side effect.

When my Mom was diagnosed with Alzheimer's in her early 80's, the doctor asked if she had ever been on estrogen replacement and she hadn't so they put her on it...a little too late. The lab lady who does my yearly mammograms told me to let her know if I ever went off the estrogen because it would make a big change in my breast tissue. I didn't like that idea.

Now my insurance company tells me my generic estrogen tablets were raised to a "tier 4" drug the first of the year and even if I can get an exemption from my doctor to continue the estrogen it will cost me $95 dollars a month... rather than the six dollars I paid for a three month supply.

Say what? Who the hell decided old women don't need their estrogen?



DMS said...

I am so sorry to hear this! I hope that everything will get worked out with the new insurance. I thought people could keep their old insurance and only had to get insurance if they didn't have it (or pay a fine). It sounds like the estrogen you have been taking has been doing wonders for you. I am keeping my fingers crossed for you that this will get taken care of soon! :)

Anna Maria said...

Thanks Jess! This wasn't a new insurance, it is the same one I've had for 12 years. They simply changed prices and what they will cover the first of the year. The gist I got from them is I don't "need" estrogen at my age so they won't cover it at all...unless my doctor can convince them I have a need...and then I have to pay $95 a month instead of the $2 I've paid for the generic version the last 12 years. My doctor is giving me another prescription and I'm going to shop around.

oneperson said...


I ran into this "tier" stuff a few months ago with my primary and secondary coverage. The medication prescribed was categorized in one "tier" in my primary and in another "tier" in my secondary.

From what I learned, insurance companies apparently have some (all?) say in how they "tier" the different medications; there isn't a standardized system.

That medication that was in 2 different tiers in my primary and secondary would have cost me $800 plus dollars for a month supply. I was floored...just at the cost of 30 pills. Good gawd. Anyway...I had to find a substitute med with my doctor.

I hope you get this figured out Anna. It's insane...insane.

PS: Last year, when I was having to jump through medical hoops and my doc would not prescribe my needed prednisone, I had good success with a pharmacy in India. I hope, hope, hope you wouldn't have to go that route. I'll be glad to help if it comes to that. Crazy...

Anna Maria said...

Well now I'm feeling "spicy" again...I did some price checking and found out I can buy a three month supply from the drug store around the corner for #10 if I pay a one time fee of #10 to join their preferred prescription plan. It does make me wonder why my insurance company wanted me to pay #95 a month for the same estrogen????????????

Anna Maria said...

Carol...that is what my insurance company did...raised it to a 4 tier drug instead of a generic 1 tier. It pays to price check. All my co-pays went up the first of the year and they "blame" it on Obama care but unless the doctors have suddenly started charging more..none of it makes sense. You might want to check with places like Walgreens to see if you can pay for yours meds on your own a lot cheaper than going through your insurance company.

oneperson said...

Thanks Anna.

Thankfully, I haven't had a problem, except for that 1 drug for which we found a substitute. The substitute was actually the same drug but with a different protein binder or something. I researched it online and according to what I read, there is no difference in the way the drug works. Weird.

But....that drug ended up not working for me anyway. *chuckle* But, now something different is working..and I'm crossing my fingers it continues to do so. :)

Glad you found a solution for your HRT. You go girl!!! *applause*