Prescription Insurance Blues

My current employer recently changed the way it funds its employee health insurance policies--and its prescription plan.

I haven't been to a doctor since the change, which took place on the first of last month.  However, yesterday I went to pick up a refill for my estrogen (Premarin) prescription.

The last time it was refilled, in August, I received a 90-day supply for a co-pay or $45.  That had been the cost almost from the time I had my surgery, about five years ago.  Before that, I was paying ten dollars for a 30-day supply.

When I went to the Callen-Lorde pharmacy center, the clerk told me that, according to the current plan, I am allowed only 30 days at a time.

That, in and of itself, would have been nothing more than an inconvenience. But the next bit of news she gave me could have a real impact on my life:  It's now $81.24 for that 30-day supply.

When I called Express Scripts, who manages the plan, the person kept on saying "I hear you, I hear you."  When I asked for an explanation, he said, "Well, it costs more now."  Well, duh.  He said I'd have to contact the insurance company, whose name he didn't have.  

"That price is for in-person pick up," he said.  "If you want it mailed to you, you can get a 90-day supply for $243.72."  Now, the highly atrophied part of my brain that does math couldn't make the calculation on the spot, but it didn't sound like a discount--and, of course, it isn't.  

"So how did the price more than quadruple in the three months since I last got my prescription.  Did cows become an endangered species or something?"
(Premarin comes from pregnant mares.) He repeated, "It costs more now."  Then he gave an ever-so-helpful suggestion:  "You should call the insurance company."

That office--or, more precisely, the office of the person who administers the plan for my employer--was closed by that time.  I left two voice mail messages yesterday: one in the morning, one in the afternoon. The second time I called, I was switched to the main number, where I was told the person I needed to talk to was "out to lunch".  On Friday, you know what that means.

I hope to hear from her on Monday.  How, exactly, does a drug I need go from $45 for a three-month supply to $81.24 for one month?

Medicare Will Accept Applications For GRS Coverage

A US Department of Health and Human Services board has just ruled that Medicare recipients can no longer automatically be denied coverage for gender-reassignment surgeries.


Of course, this does not mean that every senior citizen who wants the surgery will get it at taxpayers' expense.  Rather, it gives Medicare recipients can seek authorization for the procedure by submitting a doctor's and mental health professional's documentation stating that the surgery is medically indicated in the applicant's case.


State-run Medicaid organizations as well as private insurers often take their cues from the Federal government in setting guidelines for coverage.  So, some have suggested, today's ruling could pave the way for gender-reassignment surgery becoming a routinely-covered benefit.


Such a prospect, of course, has opponents' knickers in a twist.  They believe that "anyone and everyone" will ask for the surgery and costs will rocket to the stratosphere.  However, even the most liberal estimates indicate that transgender people are no more than 0.4 percent of the population. Moreover, preliminary research indicates that coverage of medical treatments and procedures related to transgender issues has no discernible effect on the number of people who avail themselves to them.

Getting And Keeping What We Need

Here is an infographic that shows some of the dilemmas faced by transgenders in the work force:

"Passing" Does Not Mean "Equal"

As I've mentioned in earlier posts, previous generations of transsexuals tried to go "stealth" as much as they could.  That meant, not only looking and acting as if they were members of their "new" genders, but also erasing their pasts, often to the point of creating wholly fictitious histories (Is that an oxymoron?) for themselves.

I've pointed out some of the fallacies and pitfalls of doing so.  For one thing, amnesia is not healthy; self-imposed amnesia can only be worse.  Also, as Victoria Brownworth says, a person who "passes" is trapped:  He or she believes the lie or is caught in it.  Yet, as long as we're not caught, society will reward, and even demand, such fabrications.

We see one of the major problems in "going stealth" or "passing" when we look at the law.  I used to believe that if I were to "pass" well enough, I would never have to worry about transgender equality:  If I had to throw my (all-too-considerable) weight behind a movement, it would be feminism.

Well, I still tell anyone who knows about my history that there's nothing like becoming a woman to turn you into a feminist.   While I may not have to worry about daycare (unless, of course, I adopt), I still have to think about other women's workplace and lifestyle issues because they affect me.  

One of those issues is discrimination. While a prospective employer may know nothing of my history from seeing me, and nothing of my experience of life from my resume and cover letter, he or she could always find out about those things without searching very long.  Even if I never wrote this blog, or any of my articles or essays about transitioning or living as a woman, a prospective employer could do a simple background check.

So, for that matter, could a health insurer, or any health-care provider.  Or prospective landlord or lender.  Even trans people whom other people simply cannot imagine in their birth genders run into discrimination and other difficulties as a result of having had to live their previous lives.

Those are reasons why I now realize that I simply cannot ignore the issue of LGBT rights, or think that including protections for transgenders in civil rights laws is not as important as some other issues.  Simply distancing myself from my old life will not insulate me from it.  I made my transition and had my surgery so I could live as the woman I am, but there is no point in denying that some of my experiences are different from those of other women.  More to the point, my body has a different history from those of other women:  Even if I am no longer at risk for, say, prostate cancer, I may still need treatment for some residual condition.  (Trans men encounter this when they need screening for cervical or breast cancer.)  On top of that--as I learned early in my transition--there are some medical care providers who won't treat you, give you inappropriate treatments or will harass and humiliate you because of who you are.

Those are just some of the reasons why, no matter how good we are at "passing" and how little semblance our current lives bear to our former ones, we still need to work for equality, whether it's by getting language added to the 1964 Civil Rights Act or our employers to adopt fair and equitable policies.  As someone who's spent more than her share of time in classrooms, I can tell you that simply passing doesn't mean that you're equal to anyone else.  At least, you haven't gotten there yet.

We Won't Come For What They've Built In The Beaver State

Once again, I've Kelli Busey to thank for the latest news about what's available to trans people.

She reports that in order to comply with the state's non-discrimination laws, health-care insurers cannot have riders that categorically exclude all transgender patients.  Also, the state's mandate for coverage of mental health services must also apply to transgender patients.  Furthermore, the designation of a policyholder as male or female can no longer have any bearing on the types of treatments that are covered.  So, for example, a female-to-male who is documented as male cannot be denied coverage for ovarian cancer screening.

So far, it all sounds really good, right?  Then this part will sound, at first, even better:  Insurers cannot deny coverage of treatments for transgender patients if those same treatments are covered for cisgender patients.  Therefore, if an insurer pays for a cis woman's breast reduction to lessen her back pain, it also must pay for the same treatment if it's undergone by a female-to-male transgender.  

Think about that for a moment.  It sounds good until you realize that sex reassignment procedures procedures are not done on cisgender people.  To my knowledge, no cis man has ever asked to have his genitals cut open and reconstructed as a vagina, and no cis woman has ever demanded to have an artificial penis constructed (to the extent it can be done) in place of her vagina.  Also, I don't know of any insurer that pays for cis women's breast augmentations; under the new regulations, they wouldn't be required to do so for male-to-female transsexuals.

But all of this leads to an even slipperier slope:  Insurers could still change their policies as to what they will and won't cover for cis people.  So, an insurance company might decide that it will no longer cover breast or penile implants for anyone, cis or trans.  

Somehow I don't expect to see trans people hitching their wagons to mules for cross-country treks to the Beaver State--not yet, anyway.  

SEIU Seeks Transgender-Inclusive Health Insurance

One good thing about working for the City University of New York is that it offers pretty good health insurance policies.  Mine didn't pay for my surgery; then again, not many policies do.  But I haven't had difficulty in getting other care I've needed, including follow-ups to my surgery.

On the other hand, other trans people don't have it so good.  For one thing, too many of us don't have jobs at all.  And among those of us who have one (or two or three or more part-time jobs!), too many don't have health insurance.  Some have been categorically denied insurance because they are transgendered.

At least one large labor union is looking to change that.  Yesterday, at their national conference in Denver, the Service Employees International Union (SEIU) passed a resolution saying that local groups and individual members will bargain for transgender-inclusive health-care coverage in their contract negotiations with businesses and employers. 

That resolution is significant because the SEIU is one of this country's largest unions, with 2.1 million members.  It's also meaningful because it shows that SEIU is aligning itself with organization--some of which are transgender or LGBT-specific--that are working to get organizations and companies to offer trans-inclusive health policies. 

Paying for follow-up care, as my plan does, is a good first step.  But, ultimately, we need to have policies that cover, not only surgeries, but psychological therapy and counseling as well as such things as hormones and other medications.  (For trans people, hormones are indeed medications, not recreational drugs.)  I'm not a financial analyst or accountant, but I would think that such inclusions wouldn't be as expensive for the insurers as some might expect.  For one thing, the number and percentage of people who actually go through with the therapies and surgeries is quite small, and will remain so even if the "gates" to them are opened up.  Finally, as one doctor said about gender reassignment surgery, "You only get it once."