Restrictions on Doctors prescribing TRT

[Driven Mad]

I have a friend who's been struggling with low T now for a while. 8 months ago and recently he tested just above 300 total T and experiencing textbook symptoms. His doctor told him she "can't prescribe" because he's technically within the (Labcorp) reference range. The question I'm posing here is, are Doctors explicitly prohibited from prescribing TRT based solely on the numbers? If he seeks out another Doctor, will he just be told the same thing?

I've been on TRT for 2.5 years after testing at 320 but I know the reference ranges have changed since then.

Thanks,
Driven Mad

 

[PhilM7]

You can find a clinic (hopefully there is one in your area) that will prescribe TRT, or you can use one of the online resources like Defy, that advertise on this site. However, your insurance many not cover it, because mine won't unless I drop below 200 or some crazy low number like that.

 

[Vince]

I have a friend who's been struggling with low T now for a while. 8 months ago and recently he tested just above 300 total T and experiencing textbook symptoms. His doctor told him she "can't prescribe" because he's technically within the (Labcorp) reference range. The question I'm posing here is, are Doctors explicitly prohibited from prescribing TRT based solely on the numbers? If he seeks out another Doctor, will he just be told the same thing?

I've been on TRT for 2.5 years after testing at 320 but I know the reference ranges have changed since then.

Thanks,
Driven Mad

I believe to have your insurance pay for trt, you have to test below range.

 

[Vince Carter]

Total T is the basis for the medical diagnosis of Hypogonadal, symptoms do not matter.

As one mentioned I think Defy might treat you based on symptoms or different levels of course that is a pay out of pocket situation, but I think the root breakdown is that this particular Dr can't get paid, per se, or that insurance won't pay them to treat a guy with a 300 level.

 

[xqfq]

I believe to have your insurance pay for trt, you have to test below range.

I think Vince may be right, though I’m sure it depends on insurance policy, etc. You could also try fighting the insurance company, but you’d want the doctor on board with you I’m sure.

(I, for one, believe these policies may be illegal under Section 1557 of the Affordable Care Act, which prohibits discrimination based on gender)

The good news is that testosterone is very cheap without insurance, so the lack of coverage would likely only cost him an extra ~$40 per bottle of testosterone.

I know people who are prescribed TRT via their primary care doctors and pay out of pocket for the testosterone. I’m not sure if I can post links to the site here, but there are prescription coupon sites that can reduce the cost considerably.

 

[Saul]

The question I'm posing here is, are Doctors explicitly prohibited from prescribing TRT based solely on the numbers? If he seeks out another Doctor, will he just be told the same thing?

No. My GP prescribed T when I was in the 300's. Insurance denied coverage - they just don't want to pay out. I paid cash for the prescription. My GP moved. I visited an Endo and same thing. Just depends on the Dr.

 

[Vince]

I think Vince may be right, though I’m sure it depends on insurance policy, etc. You could also try fighting the insurance company, but you’d want the doctor on board with you I’m sure.

(I, for one, believe these policies may be illegal under Section 1557 of the Affordable Care Act, which prohibits discrimination based on gender)

The good news is that testosterone is very cheap without insurance, so the lack of coverage would likely only cost him an extra ~$40 per bottle of testosterone.

I know people who are prescribed TRT via their primary care doctors and pay out of pocket for the testosterone. I’m not sure if I can post links to the site here, but there are prescription coupon sites that can reduce the cost considerably.

I see no reason why you can't post links for testosterone coupons. It definitely would benefit anyone who can use them.

 

[Systemlord]

The question I'm posing here is, are Doctors explicitly prohibited from prescribing TRT based solely on the numbers?

Too many Americans with insurance are being denied coverage

The data showed an alarmingly high rate of denial — 24 percent, nearly one in four — among consumers treating chronic or persistent illnesses. Additionally, in 70 percent of those cases, the denied treatment was for an illness or condition described as “serious.” Up to 43 percent of the individuals denied care described themselves as “in poor health.”

It's not the doctor saying no to TRT, it's the insurance company.

If you want a doctor participating in managed healthcare to prescribe TRT, you have to score a level equivalent to an elderly man (<300) because the insurance company doesn't care about your symptoms or whether you drop dead tomorrow, insurance companies are known for denying medical coverage to those that need it.

 

[DragonBits]

I have a friend who's been struggling with low T now for a while. 8 months ago and recently he tested just above 300 total T and experiencing textbook symptoms. His doctor told him she "can't prescribe" because he's technically within the (Labcorp) reference range. The question I'm posing here is, are Doctors explicitly prohibited from prescribing TRT based solely on the numbers? If he seeks out another Doctor, will he just be told the same thing?

I've been on TRT for 2.5 years after testing at 320 but I know the reference ranges have changed since then.

Thanks,
Driven Mad

I would say depends on the doctor, with the following caveats.

If you look for a doctor by using a search engine provided by either your insurance group or a medical group, you are likely to get a doctor that has to follow their policy. For instance, my doctor is a part of advocate health group, a large medical group here in Illinois. All doctors in that medical group follow the group policy. While my doctor thought TRT was a good idea, he wasn't able to prescribe for me, my total T was 350.

Insurance isn't likely to cover TRT if you are above range for total T, though that is up to the insurance company.

What annoys me, if you ask a doctor can you prescribe testosterone if my level is 350, they don't want to give you an answer, they want you to make an appointment, test you then tell you your levels is too high.

It's really all about money, if you can afford it, you can get TRT or nearly anything medical done. Defy is reasonable cost, I would use them if you can't find a doctor.

 

[BigBamBoo]

I am with Defy, but I have a walk in clinic that will fill my T prescription.
I just give them my latest blood work when I go in. They generally give me at least one refill per prescription so I only pay one office visit charge Per 6 months of T use.

I then use GoodRx coupon and go through Safeway to fill it.

RiteAide no longer takes GoodRx coupons as of Jan 1st. They seemed to be the cheapest.

I just filled my script at Safeway with the GoodRx discount it was $50 for a 10ml vial.

It takes a bit of leg work to get it all in place but once you do, you should be set.

 

[DragonBits]

I am with Defy, but I have a walk in clinic that will fill my T prescription.
I just give them my latest blood work when I go in. They generally give me at least one refill per prescription so I only pay one office visit charge Per 6 months of T use.

I then use GoodRx coupon and go through Safeway to fill it.

RiteAide no longer takes GoodRx coupons as of Jan 1st. They seemed to be the cheapest.

I just filled my script at Safeway with the GoodRx discount it was $50 for a 10ml vial.

It takes a bit of leg work to get it all in place but once you do, you should be set.

I am confused.

You are with Defy, but they don't give you a T prescription? Then why are you with Defy?

What sort of walk in clinic do you use? The clinic give you a refill, by which do you mean they give you a prescription?

If I lived in Florida, I could get a script from Defy and fill it anywhere in Flordia. But not out of state.

 

[BigBamBoo]

Yes, I get my protocol, consults, and labs through Defy but get my T refilled through the walk and in clinic.

The clinic is just a family general medical walk in clinic. Don’t know How else to explain it.
Folks use it instead of going to the ER. We have lots of them here.

 

[edvedder]

Yes, I get my protocol, consults, and labs through Defy but get my T refilled through the walk and in clinic.

I am with Defy, but I have a walk in clinic that will fill my T prescription. I just give them my latest blood work when I go in. They generally give me at least one refill per prescription so I only pay one office visit charge Per 6 months of T use.

Dude,i never knew this was an option! Am i understanding this right - can i walk in with lab tests from say discounted labs and get a prescription for T from these walk in clinics? Or is Defy actually writing the prescription ?

 

[captain]

The problem is for ones wanting to use insurance is prior authorization and has to be given every year. Defy can give you your prescription but you can't use insurance without prior authorization. If your 300 total T the insurance doctor can't give you prior authorization. Cash doctors don't do insurance or prior authorization so 300 total T don't matter. So if your over 300 your going to be paying cash or finding a way to get under 300 total T.

 

[BigBamBoo]

Dude,i never knew this was an option! Am i understanding this right - can i walk in with lab tests from say discounted labs and get a prescription for T from these walk in clinics? Or is Defy actually writing the prescription ?

I do not know if every walk in clinic will do this. I am in California where they pass out scripts for a stubbed toe...so you might have to do some leg work to find a clinic to work with where you are at.

Fo me I took the box that the T came in from EmPower and went to the clinic close to where I live.

I asked them if they did medication refills. They said yes.

I showed the Dr the EmPower box of T with the dose, etc. They just asked if I had my current labs and I gave them a copy.
They then wrote me a script for the T.

Since I have been there a few times now for this, they give me a refill so I do not have to go in every time I run out of T. So I only have to see them at most twice a year.

They only charge $30 for the office visit and with a GoodRx discount I get the 10ml of T for $50.00.
So about $130 a year for T vs $300 from EmPower, etc.

I do not have insurance....self employed....so I can not comment on how to get them to pay for T.

 

[BigBamBoo]

Another note....almost all walk in health clinics...at least here...are for profit/private clinics.
So they are more apt to work with you than your family doctor or endo who mainly deals with insurance.

Again, I am a cash pay customer, no insurance.

 

[Mr S]

Another note....almost all walk in health clinics...at least here...are for profit/private clinics.
So they are more apt to work with you than your family doctor or endo who mainly deals with insurance.

Again, I am a cash pay customer, no insurance.

Hi, how do you take care of your blood work? I assume it must be expensive without insurance

 

[BigBamBoo]

It is. I order it through Defy.