Insurance claims for gender-affirming therapies have increased, but filling prescriptions without insurance may be more affordable, new study findsJun. 28, 2022, 1:03 PM
by Jake Lowary
A new study led by researchers in the Department of Health Policy at Vanderbilt University Medical Center and students in the Vanderbilt University School of Medicine finds that both gender dysphoria diagnoses and use of gender therapies have increased substantially between 2013 and 2019.
The study was published recently in the Journal of General Internal Medicine and analyzed commercial insurance claims data and found that medical diagnoses for gender dysphoria have increased from 8.1 to 64.4 per 100,000 enrollees, or about 700%. Similarly, use of gender-affirming hormone therapy increased nearly 800% in the same period.
But while there has been significant increase in diagnoses and use of hormone therapy, the proportion of individuals with insurance claims for hormone therapy prescriptions has remained stable. The data suggest that patients are purchasing medications without insurance, unable to afford out-of-pocket costs or not interested in hormone therapy. To investigate this further, the authors dug deeper into what patients are really paying for these therapies.
The average retail price of prescription hormone therapies has a wide range, from $13 to $181 per fill for feminizing therapies and $30 to $464 per fill for masculinizing therapies, which “suggests there are vastly different prices for the same outcomes,” said Rishub Das, a second-year medical student at VUSM.
“For individuals who have their hormone therapy medications covered by insurance, it still may be advantageous to price shop and purchase medications using pharmacy benefit manager-backed programs, such as GoodRx,” said Das. “Transgender and gender-diverse patients may be on these medications chronically, and cost-conscious prescribing can make a huge difference in a patient’s quality of life and financial security.”
Das said the patterns demonstrate that only a portion of insured individuals seek or fill their prescriptions for gender-affirming therapy under their insurance plan. He recommended clinicians speak to their patients about what their medications are costing them, which can be educational and improve outcomes. Even for patients without health insurance, hormone therapy may still be an option using coupons from GoodRx.
“As insurance coverage for such therapy broadens, more patients are presenting to their primary care providers seeking gender-affirming hormone therapy, which our study demonstrates,” Das said. “The scientific literature shows that transgender and gender-diverse patients experiencing gender dysphoria can benefit from gender-affirming care, including hormone therapy.”