Medicare & Hormone Replacement

Wednesday, December 10th, 2014, 12:06 am

December 2014

Recent changes in the U.S. insurance industry have had some unsettling effects on drug benefits for our patients on Medicare.  Beginning in January of 2014 and extending through next year, many Medicare providers have withdrawn coverage or will soon withdraw coverage for traditional hormone replacement regimens.

Using studies published in journals of gerontology, they have alleged that estrogen therapy poses an unreasonable danger to older patients. They have suggested substituting antidepressants to reduce hot flushing,vaginal creams to address vaginal dryness, and generic bone stimulators to treat bone thinning.   Thus, patients would be forced to begin three medications (with their own particular risk factors) to address all the issues that estrogen therapy is addressing now, and do it all less effectively.

Obviously we are all concerned about these changes.  This is a serious limitation on the options our patients have. Many patients have been using hormone replacement therapy for many years with excellent results.   Unfortunately, there is little recourse.   There seem to be no exceptions or mechanisms for appeals of their denials.   Given the rising costs of these medications, and the extremely low cost of the proposed substitutes, it is clear that this is more of a financial, rather than a medical decision.

We encourage our patients to protest these changes with their insurance providers.  We can also work with you to find alternatives that might be more affordable, if necessary.

 

 

 

 

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