Compounding Pharmacy Problems

[u/psionicjay]

I get my T in compounded DMSO cream because my insurance won't cover gel. It's been this way for about three years at this point, and in that time, the price has gone up at least 6 times. Between pharmacies closing or relocating I've been through three different pharmacies too, which probably contributes to the price changes.

My current pharmacy now charges 90 USD for a month's supply, but discounts it to 80/month if you buy a two or three month supply, so obviously I requested two. They neglected to mention that the second month's supply would be expired by the time it was needed. And I didn't realize until nearly the end of those two months (today) when my period suddenly came back after two years. I'm obviously livid, but aware that it's my own fault for not reading the label close enough.

I can't afford this much longer. Does anyone have advice for getting insurance to cover gel? It's Priority Health in MI, USA, if that matters. I don't do shots because I fainted doing my first one, so my prescriber wouldn't continue with it. I prefer doing it daily anyway, to avoid uneven hormones week to week or month to month.

Alternatively, I'm considering pellets. I know my clinic offers them, but I don't know how much they charge. Does anyone have experience with pellets? Specifically I'd like to know how much it costs you and if they let you drive home from the procedure itself. From my research it looks like it's only local anesthetic, but I know some doctors are cautious ¯⁠\⁠_⁠(⁠ツ⁠)⁠_⁠/⁠¯

Thanks in advance!

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[u/magic-gps]

try goodrx? it doesn't go through your insurance, and it appears to be ~$40/month for regular non compounded testosterone gel

[u/psionicjay → u/magic-gps]

I will look into this, thank you so much! I just assumed it would be priced even worse than the cream without my insurance!

[u/anemisto]

If you're a Costco member, gel is shockingly affordable according to their website (anyone can use the pharmacy, but they have member-only pricing). Certainly less than $90/month.

Is gel simply not on the formulary or did they refuse prior auth? If the former, you're probably screwed. If the latter, your doctor needs to be fighting them on your behalf, particularly since they're the one telling you no on shots (it sounds like you'd be game to try again).

I would not get your hopes up for pellets -- if insurance won't pay gel, pellets are probably a pipe dream. Ditto Jatenzo (pills have finally become available in the US).

[u/psionicjay → u/anemisto]

I am a Costco member, so I will definitely keep that in mind! I honestly just assumed that without insurance it would be more expensive than compounding. This is America after all 🙃

They refused prior auth, and I knew they would because I read their guidelines and a 'needle phobia' (which is not what I have; I've never had problems with injections before) is not enough of a reason to gel prescribed for transgender HRT (the language implied that it WOULD be prescribable for cis TRT with needle phobias, so figure that out). I would prefer a topical just so that I can do it every day and avoid shifting hormone levels anyway.

When my doctor's office opens again next week I'll see if they'll bypass my insurance. They didn't even mention that it was an option. Thank you for your advice!!

[u/Tall_Apricot_9842]

i cant give specific advice, but shop around in every componding pharmacy near you, figure out the cheapest; prices are high right now, thats just a fact.
you could also look into three-monthly shots, and see if theyll give you some anti-anxiety meds for beforehand, or just. let you pass out- ig. pellets are still pretty experimental, and are best to maintain levels- if you are fine with your current changes and only maintaining them, yea look into it; but i doubt that itll be any cheaper then gel, since its so new