Art of Transliness

How To Find Out If Testosterone Is Covered By Your Health Insurance

So, in an ask we recently and quickly explained the ways to find out if testosterone is covered by your health insurance. This was basically coauthored, okay wait, pretty much exclusively authored by Adrian’s mother who is the Director of Operations at a smaller national level health insurance company. He just regurgitated what she was saying down into text on tumblr.

There are two main ways to find out if your testosterone is covered by insurance. You’ll want to tell them the form of testosterone your script was written for (gel, injectable, cream…etc and also if you’re willing to use generic, or any specific brand you want; for example the gel is made by two major manufactures, one makes “Androgel” and one makes “Testim” - they are the same thing but your insurance may only cover one!):

1a) Call the number on your insurance card to find out the number of the Pharmacy Benefit Manager (PBM). Your card may even list it specifically.  1b) Call your PBM and they should know.

OR

2) Take it to a Pharmacy - you’ll do well to go to a major pharmacy like CVS or Walgreens (not a little local pharmacy OR Walmart, mom said Walmart is BAD) And ask them to fill it. They, right there in the store, will dial into the PBM system and determine your eligibility right on the spot. They have to do this so they know what to charge you. You can ask them the amount of the script before they even fill it!

There are only like three major PBMs in the country, Caremark, Express Scripts, and the other one my mom can’t think of - but this could even be labeled on your card as well (some times you’ll have a separate card for this). Once you know your PBM you can cater your pharmacy search to those that serve your PBM, and to be sure, one pharmacy can provide for multiple PBMs.

I hope this helps with your pharmacy search!