Prior authorizations for folks with insurance
When you first start hormones, when your insurance information changes, or when route or dose of medications change, your insurance may require prior authorization. Prior authorization is the process of determining whether an insurance company will cover your medication. The process works as follows: PPMI sends your prescription to your pharmacy; typically your pharmacy will then contact PPMI to let us know if a prior authorization is needed; our PPMI team will then initiate and complete a prior authorization submission to your insurance company. A determination of coverage by the insurance company may take seven business days (or more if a denial is encountered or additional information is requested). If your prescription requires a prior authorization and you have not heard back about a determination a week after the prescription was sent, please contact us via the portal for an update.
Even with insurance coverage, prescription costs vary. If the out-of-pocket cost for your medication is cost-prohibitive, we recommend using GoodRx with your chosen pharmacy to explore options for price reductions using coupons. If the cost remains too high, we encourage you to let us know and we may be able to suggest alternative medication routes that may be more affordable. In general, if paying out of pocket, estradiol pills, spironolactone pills, and testosterone injections are the least expensive regimens; if you are concerned about medication costs, we encourage you to bring this up at your visit when you are making a medication plan. (See Choosing the route of hormone therapy that is right for you for more information.)
Special considerations for testosterone
Testosterone is a controlled substance. Based on current law, clinicians must rewrite testosterone prescriptions every 6 months. While individuals on stable testosterone regimens usually only require clinic visits and labs annually, a clinician is required to electronically resend your prescription for testosterone every 6 months when you are on a stable regimen.
We will provide prescriptions for needles and syringes with injectable medications. For those who use syringes and needles, please ensure the needle length, gauge, and syringe volume are accurate for you prior to leaving the pharmacy. The pharmacist will be the most helpful person in resolving any issues with this. If you are prescribed two different needle sizes for one syringe, it is important that you are able to attach and detach each of the needles to the syringe.
If you are having trouble finding your needles or syringes in stock at a pharmacy, please be aware that syringes and needles can also be purchased over the counter at suppliers like Amazon, Bulk Syringes, or cost-free from the non-profit Trans Needle Exchange. If you do intramuscular (IM) injections, look for a 23–25g needle that is 1 inch in length; if you do subcutaneous (SubQ) injections, look for a 23–25g needle that is 5/8 inch in length. The length of the needle you use to draw does not matter if you switch it out for one of the above, but generally a 18–20g works best to draw out medications with less resistance. Sharps disposal bins can also be purchased at the pharmacy, or sharps can be disposed of in hard plastic containers (like a laundry detergent container) labeled “Sharps” with a sealed and taped lid. More information regarding disposing of sharps (needles) in Michigan can be found here.
Prescription lengths and refills
Our clinicians typically send 3-month prescriptions with or without refills to your pharmacy. It is important to keep track of when your lab draws are due. Depending on your medical situation (the labs you have previously had, and the medications you are on), clinicians may or may not be able to provide refills when labs are overdue. Most people who have been on hormones for a year and are on a stable regimen will require annual labs.
Gel and injection medication prescriptions may be written to reflect a range of dosing (i.e., inject 50–100mg into the muscle each week as directed) to ease the process of dose adjustments. If your prescription is written in this way, please use the dose recommended by the clinician and speak with a clinician before making adjustments.
You can update your pharmacy in our system using your MyChart portal or at your next appointment. You can call your pharmacy to transfer existing prescriptions to a new pharmacy with the exception of testosterone. Because testosterone is a controlled substance, we will need to resend testosterone prescriptions to your new pharmacy.
Or call 1-800-230-7526