CVS Caremark denies (TRT) prescription

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Splash

New Member
Good Evening,

I have been a (TRT) patient stemming from low testosterone since 2016. After bloodwork confirmed my levels, I was referred to and treated successfully by a urologist ever since.

For the last year, I have had my mail order prescriptions of testosterone cypionate filled through CVS Caremark without issue. I recently submitted a refill prescription and was personally contacted by my urologist informing me that CVC Caremark is now requesting my (2) lowest testosterone levels since treatment began in 2016. Due to my lowest levels only coming in at (400-430), CVS Caremark is now denying my prescription because the levels never fell below the “New“ standard of (264-916). When I began (TRT) testosterone standards were (348-1197).

It makes me furious that for the last (5) year’s I’ve followed all protocols, stabilized my testosterone level, and have never felt better ultimately to be destroyed over insurance/government “BS”. If anyone on this forum is personally dealing with these denials, please let me know how I should proceed forward with appealing the denial.
 
Defy Medical TRT clinic doctor

bixt

Active Member
Your options are:

1. Private clinic funded by yourself

2. Get your own testosterone from the black market

3. Game the system to your advantage. Stop all treatment. At some point all exogenous testosterone will be out of your system, and your HPTA would not yet be restarted. Around 4 weeks after your last injection. You should get a very low reading at this point. Do another test a few days later, and submit these. I have heard pulling an all nighter before the test will lower levels even more, as will be doing the test in the late afternoon.
 

Splash

New Member
Your options are:

1. Private clinic funded by yourself

2. Get your own testosterone from the black market

3. Game the system to your advantage. Stop all treatment. At some point all exogenous testosterone will be out of your system, and your HPTA would not yet be restarted. Around 4 weeks after your last injection. You should get a very low reading at this point. Do another test a few days later, and submit these. I have heard pulling an all nighter before the test will lower levels even more, as will be doing the test in the late afternoon.
Thank you for that information
 

Splash

New Member
Since when does a pharmacy decide if you need something. There job is to fill the script. Tell them to go fk them selves and take your business elsewhere.Also test is not that expensive. Just cash pay if your have issues. Three years and my hospital pharmacy has never questioned my dose or asked for labs
Due to being a retired state employee, CVS Caremark was the contract my state decided to choose from for current/retired employees. I totally agree with you about the pharmacy dictators especially after I’ve been on (TRT) for 5+ years just for them to suddenly cut me off.
 

Rabbit91476

Active Member
I think when I Cho’s to buy mine cash instead of wait for insurance approvals. It was like 35$ month. How much do you think you will save. Plus’s dealing with online orders and shipping. When you can drive down the street
 

tcmi

Member
As you said, the issue is not the pharmacy, it's what your insurance does not want to cover. Insurance is not worth the effort for the testosterone itself. Use GoodRx and look for the lowest cash pay cost in your area. My last prescription was $27 using GoodRX pricing for 4 1ml vials of 200mg/ml - which lasts me about 8 weeks.
 

DadOfSonNOVA

New Member
I just paid $55 for a 90 day supply of Test Cyp from APS Pharmacy (mail order). Forget your insurance!
May we ask where/how you obtained the prescription for this? Sounds like an awesome price. If one can maintain for $55/3 months, why do most all the providers want $100+/mo? $1,200+/per year is a lot, compared to your $220/per year!
 

VacationMan

Active Member
Seems that insurance is gradually getting more and more persnickety on HRT prescriptions. I finally cut the cord with my insurance company, as they were limiting the amount I could get. Urologist writes the script for one 10 ml vial. Insurance prevents the pharmacy from filling it with a 10 ml vial. I get a fist full of tiny 1 ml vials instead.

Now? I order thru Defy and it gets shipped to me without question from Empower Pharmacy. I pay using my FSA card. Works much, much better.
 
My insurance will only cover T if you're a female transitioning to male. I've done pre-tax cash via HSA for everything except one lab/year for the last 5 years.
 

kjcmjc

Member
I also use GoodRX over my insurance. Its cheaper. I get mine from Rite Aid for $45.00 for a 10ml 200mg vial. I live in Northern Ohio. The Walgreens by where I live will not accept GoodRx. If its a controlled substance a pharmacy can deny GoodRX.
 
Due to being a retired state employee, CVS Caremark was the contract my state decided to choose from for current/retired employees. I totally agree with you about the pharmacy dictators especially after I’ve been on (TRT) for 5+ years just for them to suddenly cut me off.
Splash - I would also be inclined to contact the administrator of benefits that manages your state health care plan to let them know that the pharmacy is not following the direction of the physician's orders.
 
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