@article{24e92ea9f5ab4b7fbb6acc8a85bc0d73,
title = "Medicare Prescription Drug Plan Coverage of Hormone Therapies Used by Transgender Individuals",
abstract = "Purpose: Although pharmacologic hormone therapy represents one of the mainstays of gender-affirming therapy for transgender individuals, there are many access barriers for these therapies, including insurance coverage of these drugs. The purpose of this study was to examine Medicare coverage of hormone therapies used by transgender individuals. Methods: Using Centers for Medicare and Medicaid Services prescription drug plan formulary files, we determined plan coverage, coverage restrictions, and out-of-pocket (OOP) costs for all 10 drugs recommended in the 2009 and 2017 Endocrine Society treatment guidelines for transgender patients. Results: For masculinizing therapies, the proportion of plans providing unrestricted coverage ranged from 22% to 79% in 2010 and from 5% to 75% in 2018. For feminizing therapies, the proportion providing unrestricted coverage ranged from 24% to 100% in 2010 and from 13% to 100% in 2018. Median annual OOP costs for masculinizing therapies ranged from $232 to $1112 in 2010 and from $180 to $2176 in 2018. For feminizing therapies, OOP costs ranged from $84 to $2716 in 2010 and from $72 to $3792 in 2018. Conclusion: Our findings highlight the variability in access to guideline-recommended hormone therapies for individuals insured through Medicare.",
keywords = "Endocrine Society guideline, Medicare prescription drug plans, gender-affirming therapy, hormone therapy, transgender",
author = "Solotke, {Michael T.} and Patrick Liu and Dhruva, {Sanket S.} and Barbara Gulanski and Shah, {Nilay D.} and Ross, {Joseph S.}",
note = "Funding Information: In the past 3 years, Dr. J.S.R. has received research support through Yale University from Johnson and Johnson to develop methods of clinical trial data sharing, from Medtro-nic, Inc., and the Food and Drug Administration to develop methods for postmarket surveillance of medical devices (U01FD004585), from the Food and Drug Administration to establish the Yale–Mayo Clinic Center for Excellence in Regulatory Science and Innovation program (U01FD005938), from the Blue Cross Blue Shield Association to better understand medical technology evaluation, from the Centers for Medicare and Medicaid Services to develop and maintain performance measures that are used for public reporting (HHSM-500-2013-13018I), from the Agency for Healthcare Research and Quality (R01HS022882), from the National Heart, Lung, and Blood Institute of the National Institutes of Health (R01HS025164), and from the Laura and John Arnold Foundation to establish the Good Pharma Scorecard at Bioethics International and the Collaboration on Research Integrity and Transparency at Yale. In the past 3 years, Dr. N.D.S. has received research support through Mayo Clinic from the Food and Drug Administration to establish the Yale–Mayo Clinic Center for Excellence in Regulatory Science and Innovation program (U01FD005938), from the Centers for Medicare and Medicaid Innovation under the Transforming Clinical Practice Initiative, from the Agency for Healthcare Research and Quality (U19HS024075, R01HS025164, R01HS025402, R03HS025517), from the National Heart, Lung, and Blood Institute of the National Institutes of Health (R56HL130496, R01HL131535), from the National Science Foundation, and from the Patient-Centered Outcomes Research Institute to develop a Clinical Data Research Network. All other authors have no competing interests to disclose. Publisher Copyright: {\textcopyright} 2020, Mary Ann Liebert, Inc.",
year = "2020",
month = apr,
doi = "10.1089/lgbt.2019.0306",
language = "English (US)",
volume = "7",
pages = "137--145",
journal = "LGBT Health",
issn = "2325-8292",
publisher = "Mary Ann Liebert Inc.",
number = "3",
}