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Do any MEDICARE part D plans pay for testosterone gels

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Posted 9/21/2019 12:04 AM (GMT 0)
In the not too distance future I will be going on MEDICARE (yay). I recently switched insurances due to job change and no longer have access through my job to a very inexpensive mail order pharmacy. It looks like i will have to Switch to T shots due to expensive monthly copays. I called up my wife’s part d plan with Mutual of Omaha (she is already on medicare) just to see what they would charge. It turns out they don’t pay for gels at all, just the shots. Does anybody have a Medicare d plan that pays for the testosterone gels? Thank you...
Posted 9/21/2019 4:01 AM (GMT 0)
While we are looking for ways to convince out insurance companies to pay for stuff we sometimes forget to check for the best prices we can find if we just pay for it for ourselves. My experience was that the commercially packaged T gels were absurdly expensive no matter what I did but I found a local compounding pharmacy that would mix me up a double-strength T gel for a small fraction of the copay that my insurance would charge if they covered T gels which they don't. I pay $195 for a three month supply. That's 65 bucks a month. I could probably find it cheaper yet but the pharmacy I use is half a mile from my house and pretty convenient.
If you can't find a way to get medicare to pay you might call some local compounding pharmacies. I found a considerable variation among the prices at local compounding pharmacies but all of them were less than my out-of-pocket if I got commercially packaged stuff at a drug store.
Posted 9/21/2019 12:49 PM (GMT 0)
Try GoodRX.com
Posted 9/21/2019 1:55 PM (GMT 0)
My Aetna part D "covers" the gel as a tier 4 with a 100 or 300 gram limit per 30 days (depending on the strength). That tier is expensive until you hit catastrophic. It also requires a set of pre-auth papers from the doctor.

You didn't say what dosage, so I just picked 1%. It shows my cost as $130 / month.

Glad I'm not looking to buy that. There is a tool on the medicare site that will tell you what meds are covered on your selected plan. And remember they change the formulary every year, so meds come and meds go.
Posted 9/22/2019 2:37 AM (GMT 0)
When I had my scrip in hand and was looking for a source that wouldn't break the bank I experienced quite a bit of frustration. On several occasions I would print out a GoodRx coupon, go to the local pharmacy listed and somehow be unable to close the deal. Somehow the product codes would never line up and the price I was quoted was always three or four times the price on the coupon -- and at least twice what I was willing to pay.

Hopefully, GoodRx has sorted this out by now. I checked their prices for my area and they seem comparable to what I am paying at my local compounder. The lowest prices seem to be for gel pumps which I seem to recall were often not available. The pharmacies would usually have the packets but they were expensive.

I am mentioning the problems I had, not because I want to be discouraging but the opposite. I had to struggle but finally found a supplier I could afford. The stuff is out there for sensible prices but it's hard to find those deals. If you have trouble finding the price you need, keep looking.
Posted 9/22/2019 12:22 PM (GMT 0)
Thank you Peter for the heads up, I looked at the coupons and they do look too good to be true but I will try that avenue for sure. There are a couple of compound pharmacies near me (I live in the Baltimore area) so I will try there first...
Posted 9/22/2019 3:09 PM (GMT 0)
I had good success with GoodRx, which got me Cialis for about 80% below what Express scripts and my local pharmacy were charging me. I guess its a case by case basis
Posted 9/23/2019 12:59 AM (GMT 0)
Prato,

I've used GoodRx with great success a number of times. For whatever reason the T gel was the only time it let me down. Hopefully they've worked that out by now.
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