Medi-Cal is California's Medicaid health insurance program. It provides free or low-cost health coverage for low-income individuals, including families with children, seniors, persons with disabilities, foster care, and pregnant women.
Hormone replacement therapy (HRT) involves taking medications that contain female hormones like estrogen and progesterone. It is used to treat symptoms of menopause like hot flashes, vaginal dryness, and mood changes. HRT can also help prevent osteoporosis. The most common types of HRT are:
- Estrogen therapy
- Progestin therapy
- Combination estrogen-progestin therapy
Medi-Cal covers HRT when it is medically necessary and prescribed by a doctor. Coverage includes oral tablets, topical gels/creams, patches, implants, injections, and vaginal rings. Prior authorization may be required in some cases.
To get HRT covered by Medi-Cal, there are a few key steps:
Schedule an appointment with your doctor
- Explain your menopausal symptoms
- Discuss whether HRT is appropriate for you
- Get a prescription for HRT medications
Have your doctor submit a treatment authorization request (TAR) to Medi-Cal
- This allows Medi-Cal to evaluate if HRT meets medical necessity guidelines
- Approval is required before filling the prescription
Pick up your prescription
- Take the prescription to a Medi-Cal contracted pharmacy
- There may be a small copayment ($1-5) for the medication
Medi-Cal will cover:
- HRT consultations, evaluations, and follow-up monitoring
- Blood tests related to using HRT
- Breast cancer screening for patients using HRT
- Treatment of side effects or complications
Things to know:
- Generics are preferred if available
- Some brand names may require prior approval
- There are dispensing limits on medications
- An appeal can be filed for denials
In summary, Medi-Cal does cover FDA-approved HRT medications and related services
when medically necessary. The process involves getting a prescription, approval by Medi-Cal through a TAR, and filling it at a pharmacy. Coverage is quite comprehensive but there may be some utilization controls.
If you are experiencing uncomfortable menopause symptoms, Hormone Harmony Clinic(/) has caring doctors ready to help. We offer personalized HRT treatment plans tailored to your unique needs. As a Medi-Cal provider, we can check your coverage and file all approvals for you seamlessly. Contact us today to learn more or book an appointment to start feeling like yourself again.
