Do Medicare Part D plans Cover Hormone Replacement Including Compound Pharmacies?

We get this question often and since we're not just about "selling", we like to go deep on the topic.

After all, bio-identical hormones were a life-saver for the founder during perimenopause (that story is here).

Estradiol and progesterone literally brought her back from the brink and roughly 25% of women have debilitating perimenopauses.

Rolling panic attacks. Racing heart. Insomnia. Good times.

It's not just about hot flashes!

So... a question we get often is,

"Will Part D plans with Medicare cover my hormone replacement"?

Even more pressing, what about compound pharmacies for bio-identical hormones.

After all, the profile between progesterone and synthetic progestins are night and day (more on that here).

Bio-identical Progesterone was associated with lower breast cancer risk compared to synthetic progestins when each is given in combination with estrogen, relative risk 0.67; 95 % confidence interval 0.55-0.81.

Okay...a 33% reduction in cancer risk with bio-identical progesterone!

That's just the start and estradiol is the same.

So...let's get into it with these topics:

• Quick intro to Medicare Part D plans
• Does Part D cover hormone replacement from pharmacies
• Does Part D cover HRT from compound pharmacies
• How to quote Part D plans with HRT costs included

Let's get started!

Quick intro to Medicare Part D plans

We have deep dives on how to Save on Part D but let's get a quick recap.

Part D is a separate plan you buy to cover medications or RX.

Advantage plans generally include Part D while supplements will require a separate plan purchase for medications.

Learn more about Advantage plans versus supplements.

Hormone replacement is generally in pill, patch, or cream form for:

• Some form of estrogen (bi-est, estradiol, estriol, estrione)
• Progesterone - either bioidentical or synthetic (progestins)
• Testosterone - for both male and female subscribers albeit at different levels

There can be other hormones such as T3/T4 (thyroid) etc but the steroidal hormones above make up the vast majority of usage.

The main consideration is that hormone replacement is covered under Part D plans if covered at all.

Let's go there now.

Does Part D cover hormone replacement from pharmacies

There are many hormone replacement options that are available through a pharmacy as a standardized medication.

Most are even generic now such as:

• Estradiol
• Progesterone

This can make a ridiculously big difference in cost.

For example, we just ran a quote for a subscriber turning 65 and she wanted to include Prometrium.

Prometrium is a brand option for bio-identical progesterone.

That quote resulted in costs of $100s per month while generic was under $10.

The quoting system below will allow you to check out generic versus brand.

Keep in mind that bio-identical hormones are mainly made from Mexican yams. All the same source!

Synthetics are also covered and generally a few dollars if not zero cost but the research on synthetic is not great! More on Estradiol history for an example from site above.

So, we can usually get hormone replacements that come from a pharmacy (think CVS, etc) and even dial in the cost with Part D plans.

It needs to have a prescription of course but this is pretty standard.

Testosterone has many different options but most women don't get T from a standard pharmacy since that's still pretty forward-thinking (unfortunately).

That brings us to the compound pharmacy question.

Does Part D cover HRT from compound pharmacies

Here's where we run into issues.

Many people will get their hormones from compound pharmacies.

These are accredited pharmacies but they literally make the medications (or blend the levels) themselves.

We have clients who go this way usually to get bio-identical and/or different blends.

For example, bi-est is very popular as some naturopaths feel it's safer (learn about the whole safety question here).

It's a combination of estradiol and estriol. Also, testosterone for women is generally from compound pharmacies.

So...how do Part D and/or Medicare generally treat these options?

Not well!

Medicare and Part D (they are separate plans after all) have really cracked down on compound pharmacy hormones.

We spoke with a pharmacist just yesterday to clarify.

He said that they only see a select list of Part D plans that cover their products and they're usually unique...tied to companies, government, military, etc.

This is not the traditional Part D that's available to most people eligible for Medicare.

So...how do we address this?

Anything you can get from a standard pharmacy helps.

For example, estradiol (a few dollars per month) bioidentical versus bi-est, etc.

Obviously, you'll have to work with your doctor as many naturopaths are scared out of their minds about estradiol.

One note...we actually take 2 of the .5mg estradiol since the 1mg version has a food dye in it. Go figure.

Progesterone is easier. Bio-identical Progesterone comes in 100mg tabs from pharmacies. The only issue there might be if you compound 150mg or an odd-lot.

Testosterone for women in peri/menopause is trickier. That's generally a cream and compound pharmacies are the primary source.

Work with your doctor to see if there are options through the pharmacy that are bio-identical to match what you're compounding.

Otherwise, it's probably out of pocket. Most compound pharmacies do have 3 month bulk discounts.

Alright...how to quote all this.

How to quote Part D plans with HRT costs included

We make this free, fast, and 100% available to you here:

A few notes.

Make sure to enter your medications in the preference box.

This gets a little more complicated with HRT.

Enter your medications EXACTLY as listed on the bottle. Include dosages as well.

Also enter your preferred pharmacy and make sure to sort by "Total Estimated Cost".

See if your compound pharmacy is listed just to rule it out.

Now...you'll see in the results how many of your medications are covered. You can even click on that link to see if there ways to save (like the generic progesterone versus prometrium).

This can fix the "1 out of 2 medications are covered" situation like we saw with Prometrium in the quote we ran (literally $1000's per year).

That's something to ask your doctor or naturopath about.

Generally, HRT can be covered by Part D plans but generic really matter even for bio-identical and compound pharmacies are probably going to be out of pocket.

Until Medicare and the medical community realizes that HRT isn't just about "inconveniences".

We won't hold our breath.