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BCBS Basic Plan - Coverage for testosterone pellets?
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Rank: Newbie
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Joined: 6/16/2022(UTC) Posts: 3   Location: US
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Are there any feds out there who have the Blue Cross/Blue Shield Basic plan who have been able to get reimbursed by BCBS for testosterone pellets? I have been told by BCBS reps that the ingredients in the pellets themselves are covered, but so far, I have been unable to find a sterile compounding pharmacy that's in-network that I can get the pellets from. My understanding at this point is that no pharmacy (even in-network ones) will bill BCBS directly for compound medications, but that once you pay out of pocket for the medication, you can submit a claim for reimbursement to BCBS.
The problem has been trying to find an in-network sterile compounding pharmacy that I can get the pellets from. BCBS's pharmacy search function on the CareMark website is pretty much useless for this purpose because it will pull up every single compounding pharmacy out there, making no differentiation between ones that are sterile and ones that aren't. Plus, even among the sterile ones, many of them don't make the soy-based testosterone pellets. It doesn't matter what state the pharmacy is in, as long as it is in-network with the BCBS Basic plan and is willing to ship the pellets to me.
Any help with this would be greatly appreciated.
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Rank: Senior Member
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Joined: 8/25/2016(UTC) Posts: 6,123 Location: Midwest Thanks: 153 times
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I don't have an answer to you question. But rather than calling each pharmacy, maybe a call to the State's department of health/pharmacy board, asking them if they can tell you which pharmacy meets your criteria? |
Socialist governments traditionally do make a financial mess. They always run out of other people’s money. --Margaret Thatcher |
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Rank: Newbie
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I appreciate the suggestion, but the only thing that MIGHT get me is a list of sterile compounding pharmacies within a particular state.......and there are LOTS of compounding pharmacies in each state. Just because a pharmacy does sterile compounding though, doesn't necessarily mean they make testosterone pellets and even if they do, they then have to be in-network with BCBS, so I don't think that will really narrow things down for me very much.
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Rank: Senior Member
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Joined: 8/25/2016(UTC) Posts: 6,123 Location: Midwest Thanks: 153 times
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Originally Posted by: DrumGuy  I appreciate the suggestion, but the only thing that MIGHT get me is a list of sterile compounding pharmacies within a particular state.......and there are LOTS of compounding pharmacies in each state. Just because a pharmacy does sterile compounding though, doesn't necessarily mean they make testosterone pellets and even if they do, they then have to be in-network with BCBS, so I don't think that will really narrow things down for me very much. Yes, I am trying to limit the number of call you would need to make. If the State board can eliminate several pharmacies, all the better. I would think that BC/BS would be able to let you know which are in/out of network. From that smaller list, you would have to contact them to see if they can provide the testosterone pellets. Have you ask your normal pharmacy if they have a recommendation? |
Socialist governments traditionally do make a financial mess. They always run out of other people’s money. --Margaret Thatcher |
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https://customscripts.us/This is the link to Custom Prescriptions of Lancaster in Lancaster PA. They are in network for BCBS basic and do ship. They do sterile and non-sterile compounding. I have had different compounded hormones made by them for about 15 years. The compounding pharmacist/owner is Diane Boomsma. She's awesome. I recommend you ask your physician to write the prescription for a 90 day supply. You will get better coverage. With basic, if the prescription is under a certain $ amount, you pay more out of pocket. I switched from standard to basic this year and was not aware of this until my refill last month. Their phone number is 717-393-0518 or 888-230-5625. They're closed weekends. Hope this helps.
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I just called Custom Prescriptions and unfortunately they don't make/offer the testosterone pellets so I'm still looking if anyone knows of a pharmacy that's in-network with BCBS Basic.
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Joined: 7/5/2021(UTC) Posts: 70 Was thanked: 11 time(s) in 10 post(s)
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Originally Posted by: DrumGuy I just called Custom Prescriptions and unfortunately they don't make/offer the testosterone pellets so I'm still looking if anyone knows of a pharmacy that's in-network with BCBS Basic. Hopefully these link are helpful: https://www.fepblue.org/...ol/search?defaultUY=trueWhen I did it for my area the following information in link below: https://www.fepblue.org/...e=CVS%20PHARMACY%2000830It stated that you will have to go through Specialty Drug Program: 1-888-346-3731
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BCBS Basic Plan - Coverage for testosterone pellets?
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