Medicare Coverage Varies for Transgender Hormone Therapies

-A new study has shown substantial variability in access to guideline-recommended hormone therapies for older transgender individuals insured through Medicare. The variability in Medicare coverage and out-of-pocket costs for feminizing and masculinizing therapies are detailed in an article published in LGBT Health, a peer-reviewed journal from Mary Ann Liebert, Inc., publishers. Click here to read the full-text article free on the LGBT Health website through May 12, 2020.

The article entitled “Medicare Prescription Drug Plan Coverage of Hormone Therapies Used by Transgender Individuals” was coauthored by Michael Solotke, Yale University (New Haven, CT) and colleagues from San Francisco Veterans Affairs Medical Center (CA), University of California, San Francisco School of Medicine, Veterans Affairs Connecticut Healthcare System (West Haven, CT), Yale School of Medicine, Mayo Clinic (Rochester, MN), Yale School of Public Health, and Yale-New Haven Hospital.

Medicare coverage and out-of-pocket costs can vary widely depending on the medication regimen. Access to care and to certain medications may be limited to those with adequate means. The study showed that in 2018, the proportion of Medicare plans offering unrestricted coverage ranged from 5%-75% for masculinizing therapies and from 13%-100% for feminizing therapies. Out-of-pocket costs ranged from $180-$2,176 for masculinizing therapies and from $72-$3,792 for feminizing therapies in that same year.

“It is unfortunate when drug costs stand in the way of optimal treatment,” says LGBT Health Editor-in-Chief William Byne, MD, PhD, Columbia University Vagelos College of Physicians and Surgeons, New York, NY. “To minimize this problem, prescribers should be prepared to direct low income and inadequately insured patients to assistance programs, when available, to defray costs, particularly for the gonadotropin releasing hormone agonists for which generic preparations are not yet available.”

About the Journal

LGBT Health, published 8 times a year online with open access options and in print, facilitates and supports the work of researchers, clinicians, academics, and policymakers to address barriers to care and advance efforts to improve the health, well-being, and clinical outcomes of all LGBT and other sexual and gender minority persons. Led by Editor-in-Chief William Byne, MD, PhD, Columbia University, New York, NY, the Journal spans a broad array of disciplines and publishes original research, review articles, clinical reports, case studies, and legal and policy perspectives. Complete tables of content and a sample issue may be viewed on the LGBT Health website

About the Publisher

Mary Ann Liebert, Inc., publishers is a privately held, fully integrated media company known for establishing authoritative peer-reviewed journals in many promising areas of science and biomedical research, including Transgender Health, AIDS Patient Care and STDs, AIDS Research and Human Retroviruses, Journal of Women’s Health, and Population Health Management. Its biotechnology trade magazine, GEN (Genetic Engineering & Biotechnology News), was the first in its field and is today the industry’s most widely read publication worldwide. A complete list of the firm’s more than 90 journals, books, and newsmagazines is available on the Mary Ann Liebert, Inc., publishers website.

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