I prescribed Androgel (generic) for a patient with very low testosterone (total and free). He also has the accompanying symptoms. He tried to use his insurance and I needed to waste time doing a prior authorization. Here was their response:
You requested the drug listed above for your late-onset (age-related) hypogonadism. A drug is covered when the diagnosis and the criteria for use is compendia supported. The accepted use of this drug for your illness requires you to have either primary hypogonadism (congenital or acquired)- testicular failure from conditions such as cryptorchidism, bilateral torsions, orchitis, vanishing testis syndrome, orchiectomy, Klinefelter syndrome, chemotherapy; or toxic damage from alcohol or heavy metals; or testicular hypofunction (non-age related); OR hypogonadotropic hypogonadism (congenital or acquired)- idiopathic gonadotropin or luteinizing hormone-releasing hormone deficiency, or pituitary-hypothalamic injury from tumors, trauma, or radiation. The safety and efficacy of testosterone therapy have not been established in men with late-onset (age-related) hypogonadism. Humana decides if the use of a drug follows accepted standards on a case-by-case basis. We take into consideration the major compendia (drug guides). Humana has determined that the off-label use of this drug for your condition is not medically accepted and is excluded from the members benefit.
What a bunch of horseshit. Why do people need insurance when they can hardly ever use it and it costs as much as a house mortgage? It’s time to break away from their teat.Tweet