Insurance Companies--clueless!!

[DrJMW]

I just received Caremark's latest Primary Drug List (drugs they cover). What a laugh. The only androgens they list are androderm and testoderm--no injectables or orals on the list..but they do list HGH like nutropin and humatrope. No antiestrogens other than Evista (specific for females). No nolvadex, clomid, aromasin, femara. This is a shame.

 

[diamonddiceclay]

does that mean that a 56 year old woman who is prescribed hgh humatrope can get it covered by insurance?

 

[whodaman]

do you think insurance companies will cover HgH for a 25 year old even if it is not prescribed by my primary care physician?

 

[DrJMW]

I think that as long as a diagnosis of GH deficiency exists, then it may be covered..the 56 yo woman will probably have GH deficiency based on blood testing. If no proof is required from the doctor and just his diagnosis of GH deficiency is accepted, then the 25 yo is in good shape. My own insurance plan covers anabolics, but you must submit for "pre-certification" for HGH--IE they require an explanation and possibly proof. Each insurance plan is different. You need to look at each individual list to see what is covered and what is excluded or what requires pre-certification.