The Re-imagination Program
Posted: December 2, 2014 Filed under: Testosterone | Tags: Androgel, androgyny, doctors, gender, gender identity, genderqueer, insurance, lgbtqia, medical treatment, non-binary, queer, testosterone, trans, transgender 12 CommentsI’ve been using Androgel, daily, for over a year and a half now. And I’m just now getting a full understanding about how the prescription & insurance industrial complex works as it relates to me continuing to get what I need. Here are a few experiences that, each taken separately, are small, but as a collection of anecdotes, are kinda mind-boggling:
– My first doctor initially tried to sway me toward a different product, Fortesta, telling me I could save big, and handed me a discount card I could activate. I went through all the hoops only to learn I was not eligible because I am not male. When I came back to him with this, he changed my prescription to Androgel without further discussion.
– Although I made clear to him that I was aiming to be on a very low dose, and see what happens from there (like 1-2 pumps), he wrote the script out as 4-6 pumps daily. This led me to be able to get 2 bottles at one time for $25. This amount lasted me for 4 months. At $6.25 per month, I wasn’t about to speak up about the inaccuracy!
– The prescription wording has changed over time (and between two doctors), and I’ve felt confused as to how that equates to how much I’m getting and how much I’m paying. I’ve paid $25 for 2 bottles together, $50 for two bottles together, and even $50 for only one bottle at one point. I guess I assumed it fluctuated in price. I thought I was paying per bottle.
– I’m not paying per bottle. I’m paying per month. My payment, I finally found out, should be $25 per month (not too bad!), but somehow I’ve continued to avoid even having to pay that much. I also have been able to store some bottles in reserves (which helps me feel much more secure since most of my visits to the pharmacy have led to some sort of questioning, calling of my doctor office, etc. Not for anything personally about me, but because of how the script was written out.)
Basically, while talking to my insurance company (using the pharmacy’s phone) last week, I learned that all that matters is how the script is written. Testosterone is a controlled substance. I always have to pick up the prescription at my doctor’s office and show a picture ID. I can never get a refill (although my doctor has tried!) If the doctor writes the dose out as 1-2 pumps per day, the higher amount is factored in. If it’s 4-6 pumps, it’s 6 pumps, even if I’m only actually using one. No one seems concerned about whether the amount correlates to what I’m doing. I can get a 30 day supply, a 60 day supply, or a 90 day supply. I’d prefer the 90 day because it means I don’t have to go as frequently. But if it’s entered as a 30 day supply, it’s 1/3 of the price. And no one actually seems concerned with whether that translates into how frequently I go to the pharmacy. Interestingly, I could pay a whole lot more to get the amount I use, or I could pay a whole lot less to get more than the amount I use. I don’t understand this logic, but I do finally understand this system.
When I was told I’d be paying $50 for one bottle and would have to come back in 2 months with a new prescription, for my 2nd bottle (due to the wording of the script) last week, I argued with that. The pharmacist got me on the phone with my insurance (which led to me finally grasping how this works). I realized the only way around it was to get the script re-written by my doctor.
I asked the pharmacist if I could get a discount card for Androgel. This is called “The Restoration Program.” Due to my experience with the Fortesta discount card, I wasn’t holding my breath. The pharmacist got me started and then handed the phone to me to complete the activation process with an Androgel representative. He was friendly and smooth. I was asked a lot of questions: name, address, email, phone number, etc. I was asked if I’ve read all the terms and conditions. Since I had just been handed the booklet with mass amounts of fine print 2 minutes prior, I just said, “yes.” I was then asked, “Are you MALE?” He said the word, “male,” in such a harsh, abrasive tone; all customer-serviceness left his voice. I paused for a good long while. Repeated the question back to him. Said, “No.” Said, “I’m not legally male; if there is any other criteria under which someone could be male, I’m interested in that.” But his helpfulness was long gone. I felt mildly humiliated; he just kept grinding it in that he could do nothing further for me.
My jaded brain (during a conversation with my partner’s jaded brain, haha) decided that men are rewarded for using Androgel because the company is trying to promote a specific type of patient for their product. Rugged, middle-aged, robust and vigorous. Masculine. Diagnosed with low testosterone, just needing a boost. Just take a look at the pics of men on their website:
Androgel website
I am nothing like the men on the website. However, I am just as worthy of being eligible for a discount program! I would call it “The Re-imagination Program.” Testosterone has certainly aided me in re-imagining who I am and what I can do / who I can become.
I told the pharmacist I wasn’t eligible. He acted surprised, but my jaded brain decided he already knew. The next day, I called my doctor’s office; asked for the prescription to be written the way it had previously been written. Got a call back that it was all set; ready for pick-up. Picked up the prescription, went back to the pharmacy, got my 3 month supply for $50. Anticipating more hassles in the future…
janitorqueer 
I remember having similar issues when I was using Androgel, especially when I was using the packets before I started getting the pumps. It seemed like it got cheaper the higher the dose went for some reason and I never did figure it out. One time the pharmacy messed up and gave me about 6 months worth at one time. Oops. Sorry you had that experience with their customer service rep but it doesn’t surprise me. I don’t think they want us using their product but don’t mind taking our money.
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exactly! they don’t mind the money, but they don’t want to hear from us! oh well…
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That sounds really tough. I hope that it gets better in the future but from your post I get the feeling that it most likely won’t. Still, I wish you luck.
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I’m realising how lucky I am living in Sweden with the healthcare system we have. None of this would happen here, and you could report the company’s discount system for discrimination – and they would be forced to change it. I truly have a hard time understanding how your healthcare system works and the more I get to know, the more confused I am. It sucks to have to learn how to “play the system”.
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yep, it feels like discrimination. I also have a hard time understanding how our healthcare system works!
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Frustrating for you, but the system is also funny.
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If I was you I would call the people at Androgel back up and demand that you get the savings card. I had a look at their website along with their eligibility criteria, along with their terms and conditions and nowhere does it say you have to be legally male to be on the program. If the person on the other end refuses to activate the card then ask to speak to their supervisor. If the supervisor will not activate the card then ask him where in the terms and conditions or eligibility criteria that it says you have to be male to be on the program. If they still insist on not being helpful then mention that you might consider legal means because your being discriminated against because of your gender and they have misleading advertising.
Don’t let their bias about their product make you feel humiliated. You meet the criteria so demand they give it to you. It doesn’t matter that your not using the product that fits their market image. You may not be able to afford legal action against them but don’t let that stop you. Often times you have to bluff and be a pain to get what you want and are legally entitled to at times. They are afraid of bad press and getting a bad image so use that against them. I bet you they will soon give you the discount just to keep you quiet.
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I really appreciate your passion! I didn’t read all the fine print given to me by pharmacist (much more thorough than what can be gleaned from the website), but I did read it through for the Fortesta (another testosterone product) discount card, and yep, the “eligible for males only” was in there.
Also, it doesn’t come out and say it on the Androgel website, but once you start going through the process to “activate your card,” it asks if you are male (a few questions in…)
Would you suggest that even with that prompt and the not being able to continue activating the card if you’re not male, I go ahead and demand that I have legal grounds to be given the service? I think probably not…
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I would suggest it indeed. Also I would try to call again and see if you can get someone else that might activate it. The time you called you might have reached someone who was not being professional and letting their personal bias not company policy dictate that you should be denied. Given his attitude toward you after “Are you male?” then I think might be the case. We might be making a very bad assumption about Androgel based on the actions of one person and Fortesta’s policy.
Also if you already have a saving card from the pharmacist or doctor then you can activate on line on their website. There they say “All questions are option, unless otherwise indicated” so that would include the gender question which you could leave blank if you think not answering male will cause you to be denied.
As far as I see you have nothing to lose by trying a few different avenues and they end up going nowhere. If you do manage to get it activated then its worth it for the money you will save.
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Again, I appreciate your passion and intensity. It got me to try a little bit harder despite gut feelings to just let it go. Although it may say, “all questions are option, unless otherwise indicated,” each field IS otherwise indicated (other than Address Line 2 – used for apartment # if applicable).
I could NOT move forward until I checked a gender box (and answered every other question as well), and when I checked female, it directed me to this message –
“This site is only intended to address Low Testosterone in men. If you’re inquiring on behalf of your male spouse or partner, please select “My partner or loved one has been prescribed AndroGel 1.62%” above.”
Thanks for your push. I feel it’s well intentioned. I certainly do assert myself as needed, and this is one of those “Pick Your Battles” things
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Your welcome. Your right it is one of those “Pick Your Battles” things. It is too bad that the company relies on subtle suggestions instead of coming out and saying that in their terms and conditions. Leading people like yourself down a path of disappointment. 😦
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My experience with paying for testosterone has been similar. On my low dose, the smallest bottle (1mL) lasts 2 months, and insurance would only pay for “one month’s supply” so they wouldn’t cover it! I think I paid out of pocket, and then asked the doctor to write it for a higher dose. Getting the 10mL bottle (which lasts well over 6 months) costs me $10, my co-pay, whereas getting it monthly (when it is covered) costs the same.
Trans people put a wrench in an already convoluted insurance system with strict rules and conditions which don’t take into account cases like ours. I wouldn’t beat myself up about being confused.
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