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Author Topic: Discontinuing TRT for Insurance Purposes  (Read 3190 times)

teancum144

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Discontinuing TRT for Insurance Purposes
« on: November 03, 2015, 01:31:03 am »
My insurance has discontinued coverage of my TRT due to the following:

http://www.peaktestosterone.com/forum/index.php?topic=3224.msg28025#msg28025

So, I've gone off my daily Sub-Q injections cold turkey so I can get a blood test that they will accept to qualify for coverage (they require two morning blood tests that are below range). However, after two days, I feel absolutely awful -- short of breath, aches, pains (occasional chest pains), exhausted, difficulty focusing, difficulty concentrating, insecure, irritable, emotional, no confidence. The change is astonishing. I plan to get the tests Wed and Thurs of this week. However, I'm worried that this is dangerous. I fee horrible. Will I be okay, or could this be life threatening?
Age 49; Height 6'3"; 235 lbs; HRT started 4/29/14;
Testosterone dose: 0.06 cc (12 mg) daily of 200 mg/ml T-Enanthate Sub-Q
Anastrozole dose: discontinued

4/17/14 test results (prior to HRT):
TT: 418 (250-1100 ng/dL); FT: 41.6 (46.0-224.0 pg/mL); BT: 83.8 (110.0-575.0 ng/dL)
Estradiol: 24 (<29 pg/mL)

6/17/14 test results:
TT: 541 (250-1100 ng/dL); FT: 59.7 (46.0-224.0 pg/mL); BT: 125.4 (110.0-575.0 ng/dL); DHT 34 (16 - 79 ng/dL)
Estradiol: 23 (<29 pg/mL); Estrone: 52 (< or = 68 pg/mL); Estriol: <0.10 (< or = 0.18 ng/mL)

9/10/14 test results:
TT: 1524 (250-1100 ng/dL); FT: 170.6 (46.0-224.0 pg/mL); BT: 388.0 (110.0-575.0 ng/dL)
Estradiol: 40 (<29 pg/mL); Estrone: 35 (< or = 68 pg/mL); Estriol: <0.10 (< or = 0.18 ng/mL)

10/22/14 test results:
TT: 829 (250-1100 ng/dL); FT: 126.5 (46.0-224.0 pg/mL); BT: 265.7 (110.0-575.0 ng/dL)
Estradiol: 23 (<29 pg/mL); Estrone: 25 (< or = 68 pg/mL); Estriol: <0.10 (< or = 0.18 ng/mL)

PeakT

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Re: Discontinuing TRT for Insurance Purposes
« Reply #1 on: November 03, 2015, 01:32:50 am »
My insurance has discontinued coverage of my TRT due to the following:

http://www.peaktestosterone.com/forum/index.php?topic=3224.msg28025#msg28025

So, I've gone off my daily Sub-Q injections cold turkey so I can get a blood test that they will accept to qualify for coverage (they require two morning blood tests that are below range). However, after two days, I feel absolutely awful -- short of breath, aches, pains (occasional chest pains), exhausted, difficulty focusing, difficulty concentrating, insecure, irritable, emotional, no confidence. The change is astonishing. I plan to get the tests Wed and Thurs of this week. However, I'm worried that this is dangerous. I fee horrible. Will I be okay, or could this be life threatening?

You sure?  Some of us, including myself, thought that they discontinued coverage but all that was needed was a prior auth.
THE MOST COMPREHENSIVE BOOK ON TRT/TESTOSTERONE:
https://www.amazon.com/Natural-Versus-Testosterone-Therapy-Myer/dp/1523210532/ref=sr_1_1?ie=UTF8&qid=1499116128&sr=8-1&keywords=natural+versus+testosterone+therapy
And check out my New Peak Testosterone Program: http://www.peaktestosterone.com/peak_testosterone_program
If you are on medications or have a medical condition, always check with your doctor first before making any lifestyle changes or taking new supplements.  And low testosterone is a medical condition.

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Re: Discontinuing TRT for Insurance Purposes
« Reply #1 on: November 03, 2015, 01:32:50 am »


kcrunner

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Re: Discontinuing TRT for Insurance Purposes
« Reply #2 on: November 03, 2015, 12:38:04 pm »
Are they just denying coverage for the testosterone?   Its a generic and not crazy expensive, you could just pay for the prescription out of pocket or out a flex plan.   

When I do a search of local drug prices, you can get a pack of 10 200 mg testosterone cyp vials for $90.50 cents.
Age: 43
Height: 6,1
Weight: 180
Total Testosterone: 829 ng/dl
Free Testosterone: 22 ng/dl
Current Meds:  Levothyroxine 175mcg, Testosterone Cyp Intra-Muscular 100 mg every 5 days.
Supplements-
Multivitamin
Magnesium
Vitamin D
B Complex
Fish Oil

teancum144

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Re: Discontinuing TRT for Insurance Purposes
« Reply #3 on: November 03, 2015, 03:18:21 pm »
You sure?  Some of us, including myself, thought that they discontinued coverage but all that was needed was a prior auth.
Yes, my doctor put me on Testosterone because my free and bioavailable testosterone were below range as follows:
  • Free Testosterone: 41.6 (46.0-224.0 pg/mL)
  • Bioavailable Testosterone: 83.8 (110.0-575.0 ng/dL)
However, my total testosterone was within range, as follows:
  • Total Testosterone: 418 (250-1100 ng/dL)
Apparently, the insurance company considers only total testosterone when considering a prior authorization.

Are they just denying coverage for the testosterone?   Its a generic and not crazy expensive, you could just pay for the prescription out of pocket or out a flex plan.   

When I do a search of local drug prices, you can get a pack of 10 200 mg testosterone cyp vials for $90.50 cents.
Yes, if you view the link in my original post, they are basing their decision on that FDA warning. Also, I posted the letter I received from my insurance company. Without coverage, my cost is about $70 per month. With coverage, it is $10 per month. If I'm on this medication for life, that adds up. My flex spending gets eaten up by my kids orthodontics and other medical expenses.
Age 49; Height 6'3"; 235 lbs; HRT started 4/29/14;
Testosterone dose: 0.06 cc (12 mg) daily of 200 mg/ml T-Enanthate Sub-Q
Anastrozole dose: discontinued

4/17/14 test results (prior to HRT):
TT: 418 (250-1100 ng/dL); FT: 41.6 (46.0-224.0 pg/mL); BT: 83.8 (110.0-575.0 ng/dL)
Estradiol: 24 (<29 pg/mL)

6/17/14 test results:
TT: 541 (250-1100 ng/dL); FT: 59.7 (46.0-224.0 pg/mL); BT: 125.4 (110.0-575.0 ng/dL); DHT 34 (16 - 79 ng/dL)
Estradiol: 23 (<29 pg/mL); Estrone: 52 (< or = 68 pg/mL); Estriol: <0.10 (< or = 0.18 ng/mL)

9/10/14 test results:
TT: 1524 (250-1100 ng/dL); FT: 170.6 (46.0-224.0 pg/mL); BT: 388.0 (110.0-575.0 ng/dL)
Estradiol: 40 (<29 pg/mL); Estrone: 35 (< or = 68 pg/mL); Estriol: <0.10 (< or = 0.18 ng/mL)

10/22/14 test results:
TT: 829 (250-1100 ng/dL); FT: 126.5 (46.0-224.0 pg/mL); BT: 265.7 (110.0-575.0 ng/dL)
Estradiol: 23 (<29 pg/mL); Estrone: 25 (< or = 68 pg/mL); Estriol: <0.10 (< or = 0.18 ng/mL)

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Re: Discontinuing TRT for Insurance Purposes
« Reply #3 on: November 03, 2015, 03:18:21 pm »


PeakT

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Re: Discontinuing TRT for Insurance Purposes
« Reply #4 on: November 03, 2015, 04:38:53 pm »
You sure?  Some of us, including myself, thought that they discontinued coverage but all that was needed was a prior auth.
Yes, my doctor put me on Testosterone because my free and bioavailable testosterone were below range as follows:
  • Free Testosterone: 41.6 (46.0-224.0 pg/mL)
  • Bioavailable Testosterone: 83.8 (110.0-575.0 ng/dL)
However, my total testosterone was within range, as follows:
  • Total Testosterone: 418 (250-1100 ng/dL)
Apparently, the insurance company considers only total testosterone when considering a prior authorization.

Are they just denying coverage for the testosterone?   Its a generic and not crazy expensive, you could just pay for the prescription out of pocket or out a flex plan.   

When I do a search of local drug prices, you can get a pack of 10 200 mg testosterone cyp vials for $90.50 cents.
Yes, if you view the link in my original post, they are basing their decision on that FDA warning. Also, I posted the letter I received from my insurance company. Without coverage, my cost is about $70 per month. With coverage, it is $10 per month. If I'm on this medication for life, that adds up. My flex spending gets eaten up by my kids orthodontics and other medical expenses.

Wow.  Well, thx for nothing, right?

Well, my PCP has a pharm tech on site, and he told me that I could get a 6 month supply for like $50 or $100.  It was very inexpensive.  They key is to find inexpensive testing, which you can do thru the labs on this site, and a good doc to make you do that testing and look over all your standard physical stuff.  That should not be an expensive proposition though.  Btw, Defy is a quite cost effective option from what I have heard and obviously you've got some of the best docs around.
THE MOST COMPREHENSIVE BOOK ON TRT/TESTOSTERONE:
https://www.amazon.com/Natural-Versus-Testosterone-Therapy-Myer/dp/1523210532/ref=sr_1_1?ie=UTF8&qid=1499116128&sr=8-1&keywords=natural+versus+testosterone+therapy
And check out my New Peak Testosterone Program: http://www.peaktestosterone.com/peak_testosterone_program
If you are on medications or have a medical condition, always check with your doctor first before making any lifestyle changes or taking new supplements.  And low testosterone is a medical condition.

xrayguy

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Re: Discontinuing TRT for Insurance Purposes
« Reply #5 on: November 03, 2015, 09:42:23 pm »
I was on T for 5 months and when I stopped cold turkey, I had all the symptoms you describe. After about 4-5 days, I started to get improvement in most all the symptoms. I am about 20 days off T now and there is a slight decrease in bad symptoms as each day goes by, however the chest tightness and shortness of breath is quite noticable. I actually think the rapid drop in T causes a stress response in your body (an adrenal fatigue scenario). Try getting out for some LIGHT exercise every day (just walk for 20 minutes). I know this is hard, I spent the first 3 days off T in bed. You have been on T much longer however and testicular recovery is relative to dose and duration of treatment.
Age 48, 5'10" 185lbs, from Canada

Symptoms: Anxiety, abdominal bloating/cramps/tenderness, fatigue, weakness, insomnia.

Rx treatment:
10/21/2015: NOTHING
10/15/2015: 120mg Testosterone cream
9/11/2015: 100mg Testosterone cream, 10/5/2.5mg Cortef
8/1/2015: 100mg Testosterone cream
7/23/2015: 100mg Testosterone cream, 15mg Thyroid
6/30/2015: 100mg Testosterone Cypionate/week, 0.5mg Arimidex 2x/week

Recent Tests March 2016:
T 234 ng/dl (297-850)
E2 19 pg/ml (<54)
SHBG 0.23 (0.20-1.00)
DHEAS 11.8 umol/L (<14.0)
TSH 4.63 mU/L (0.2-4.0)
Free T3: 6.2 pmol/L (3.5-6.5)
Free T4: 16.2 pmol/L (9.0-23.0)
Cortisol AM 279 nmol/L (120-620)
Cortisol PM 166 nmol/L (85-460)

Previous Tests:
T (300-1100ng/dl): 579>507>182>300>369>234
E2 (<54pg/ml): 72>59>43>28>25>19

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Re: Discontinuing TRT for Insurance Purposes
« Reply #5 on: November 03, 2015, 09:42:23 pm »