Medicare Prescription Drug Plan Coverage of Hormone Therapies Used by Transgender Individuals

Solotke, Michael T.; Liu, Patrick; Dhruva, Sanket S.; Shah, Nilay D.; Ross, Joseph S.

doi:10.1089/lgbt.2019.0306

Cited by 11 publications

(3 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…7 Even for people with insurance, reports of insurance denials are common, 8 and many people report that deductibles and other out-of-pocket costs like copays and coinsurance for hormones and surgeries are a major economic barrier to pursuing gender-affirmation care. 9 One study using Centers for Medicare and Medicaid Services prescription drug plan formulary files found that out-of-pocket costs for gender-affirming hormone therapy can be substantial, ranging between $84 to $2,716 in 2010 and from $72 to $3,792 in 2018. 10 Moreover, insurers often require proof of referral letters for hormone initiation as well as surgical procedures from mental health professionals, which can also serve as a limiting factor given the inadequate workforce capacity of gender-affirming therapists, counselors, social workers, primary care providers, and surgeons, particularly in geographical areas that are prone to insurance network inadequacy issues and policy restrictions in the US.…”

Section: Introductionmentioning

confidence: 99%

Utilization and Costs of Gender-Affirming Care in a Commercially Insured Transgender Population

Baker

Restar

2022

J. Law. Med. Ethics

View full text Add to dashboard Cite

Many transgender people need specific medical services to affirm their gender. Gender-affirming health care services may include mental health support, hormone therapy, and reconstructive surgeries. Scant information is available about the utilization or costs of these services among transgender people, which hinders the ability of insurance regulators, health plans, and other health care organizations to plan and budget for the health care needs of this population and to ensure that transgender people can access medically necessary gender-affirming care. This study used almost three decades of commercial insurance claims from a proprietary database containing data on more than 200 million people to identify temporal trends in the provision of gender-affirming hormone therapy and surgeries and to quantify the costs of these services.

show abstract

Section: Introductionmentioning

confidence: 99%

Utilization and Costs of Gender-Affirming Care in a Commercially Insured Transgender Population

Baker

Restar

2022

J. Law. Med. Ethics

View full text Add to dashboard Cite

show abstract

“…Our results demonstrate that self-pay or “other” payment methods had lower hospital costs per stay compared to private insurance. In contrast, Medicare had a significantly higher association with hospital cost per stay, possibly due to improved coverage for gender-affirming surgery and hormone therapy since 2014 ( 39 ). However, despite improved coverage, hormone therapies remain expensive, and prior authorizations and formulary restrictions mitigate advances ( 37 ).…”

Section: Discussionmentioning

confidence: 99%

Is gender dysphoria associated with increased hospital cost per stay among patients hospitalized for depression? Focus on the racial and regional variance in US hospitals

Kim,

Medina,

Park

et al. 2024

Front. Public Health

View full text Add to dashboard Cite

IntroductionIndividuals with gender dysphoria do not identify with their sex assigned at birth and face societal and cultural challenges, leading to increased risk for depression, anxiety, and suicide. Gender dysphoria is a DSM-5 diagnosis but is not necessary for transition therapy. Additionally, individuals with gender dysphoria or who identify as gender diverse/nonconforming may experience “minority stress” from increased discrimination, leading to a greater risk for mental health problems. This study aimed to identify possible health disparities in patients hospitalized for depression with gender dysphoria across the United States. Depression was selected because patients with gender dysphoria are at an increased risk for it. Various patient and hospital-related factors are explored for their association with changes in healthcare utilization for patients hospitalized with depression.MethodsThe National Inpatient Sample was used to identify nationwide patients with depression (n = 378,552, weighted n = 1,892,760) from 2016 to 2019. We then examined the characteristics of the study sample and investigated how individuals’ gender dysphoria was associated with healthcare utilization measured by hospital cost per stay. Multivariate survey regression models were used to identify predictors.ResultsAmong the 1,892,760 total depression inpatient samples, 14,145 (0.7%) patients had gender dysphoria (per ICD-10 codes). Over the study periods, depression inpatients with gender dysphoria increased, but total depression inpatient rates remained stable. Survey regression results suggested that gender dysphoria, minority ethnicity or race, female sex assigned at birth, older ages, and specific hospital regions were associated with higher hospital cost per stay than their reference groups. Sub-group analysis showed that the trend was similar in most racial and regional groups.ConclusionDifferences in hospital cost per stay for depression inpatients with gender dysphoria exemplify how this community has been disproportionally affected by racial and regional biases, insurance denials, and economic disadvantages. Financial concerns can stop individuals from accessing gender-affirming care and risk more significant mental health problems. Increased complexity and comorbidity are associated with hospital cost per stay and add to the cycle.

show abstract

“…This may be due to lack of access to hormone therapy, which is an important component of health and gender-affirming care [ 91 , 92 ]. Even with insurance, coverage of masculinizing hormone therapy can vary from 5% to 75%, and coverage of feminizing therapies can vary from 13% to 100% [ 93 ]. Lack of access and coverage can lead to sourcing hormone-related medications from unreliable sources, such as the internet [ 94 , 95 ].…”

Section: Discussionmentioning

confidence: 99%

Gender Identity, Disability, and Unmet Healthcare Needs among Disabled People Living in the Community in the United States

Mulcahy

Streed

Wallisch

et al. 2022

IJERPH

View full text Add to dashboard Cite

Disabled adults and transgender people in the United States face multiple compounding and marginalizing forces that result in unmet healthcare needs. Yet, gender identity among disabled people has not been explored, especially beyond binary categories of gender. Using cross-sectional survey data, we explored the rates of disability types and the odds of unmet healthcare needs among transgender people with disabilities compared to cisgender people with disabilities. The rates of disability type were similar between transgender and cisgender participants with two significant differences. Fewer transgender participants identified physical or mobility disability as their main disability compared to cisgender participants (12.31%/8 vs. 27.68/581, p < 0.01), and more transgender participants selected developmental disability as their main disability compared to cisgender participants (13.85%/9 vs. 3.67%/77, p < 0.001). After adjusting for sociodemographic characteristics, the odds of disabled transgender participants reporting an unmet need were higher for every unmet need except for preventative services.

show abstract

Medicare Prescription Drug Plan Coverage of Hormone Therapies Used by Transgender Individuals

Cited by 11 publications

References 20 publications

Utilization and Costs of Gender-Affirming Care in a Commercially Insured Transgender Population

Utilization and Costs of Gender-Affirming Care in a Commercially Insured Transgender Population

Is gender dysphoria associated with increased hospital cost per stay among patients hospitalized for depression? Focus on the racial and regional variance in US hospitals

Gender Identity, Disability, and Unmet Healthcare Needs among Disabled People Living in the Community in the United States

Contact Info

Product

Resources

About