Clomid & Insurance

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  • mcintoda
    Registered User
    • Nov 2016
    • 149
    #1

    Clomid & Insurance

    Has anyone experience with insurance and Clomid for hypogonadism from TC/chemo? So far the insurance auto-denies this drug because it's considered a fertility drug (for women). Testosterone is covered, however.

    Is it worth trying to apply for an exemption or similar?

    The cost is $35/mo to pay out-of-pocket.
    Age 31 - Portland, OR
    01NOV16- Pain in right testicle, palpable mass
    13NOV16- R I/O. Markers normal
    27NOV16- Stage Ia non-seminoma, 1.3cm, 100% EC, no LVI
    06DEC16 - CT scan clear
    09DEC16 - Started 1xBEP. Neutropenic at day 15; Worst part for me was bleo (allergic).
    03JAN17- Ended 1xBEP; start surveillance
    18MAR17-2nd pathology report shows 90% EC , 10% seminoma
    Tags: None
  • Trekga
    Registered User
    • Jan 2017
    • 882
    #2
    Great question. I think it is worth trying to apply for an exemption if the financial burden of the medication is enough. Wondering what others have done.
    Son Grant
    dx 12/21/16 at age 17
    BEP x3
    Post Chemo CT Scan on 3/28/17 still showed a few nodes over 2 cm
    2nd Post Chemo CT Scan on 4/27/17 showed all nodes still over 2cm
    Post Chemo RPLND 5/8/17: Periaortic Teratoma, Intraaorticaval Teratoma, and Paracaval Teratoma found.

    Comment

    • Mike
      Administrator
      • Apr 2008
      • 973
      #3
      I would apply as it seems like it is a pretty easy checkbox denial that they are giving you and have no idea that you are male and it is being used for hypogonadism. If you need any help from a pharmacist perspective, then just let me know.

      Mike
      Oct. 2005 felt lump but waited over 7 months.
      06.15.06 "You have Cancer"
      06.26.06 Left I/O
      06.29.06 Personal Cancer Diagnosis Date: Got my own pathology report from medical records.
      06.30.06 It's Official - Stage I Seminoma
      Surveillance...
      Founded the Testicular Cancer Society
      6.29.13 Summited Mt. Kilimanjaro for 7th Cancerversary

      For some reason I do not get notices of private messages on here so please feel free to email me directly at [email protected] if you would like to chat privately so as to avoid any delays.

      Comment

      • mcintoda
        Registered User
        • Nov 2016
        • 149
        #4
        I asked my doctor to resubmit under different code and the insurance approved it in the end. Just FYI
        Age 31 - Portland, OR
        01NOV16- Pain in right testicle, palpable mass
        13NOV16- R I/O. Markers normal
        27NOV16- Stage Ia non-seminoma, 1.3cm, 100% EC, no LVI
        06DEC16 - CT scan clear
        09DEC16 - Started 1xBEP. Neutropenic at day 15; Worst part for me was bleo (allergic).
        03JAN17- Ended 1xBEP; start surveillance
        18MAR17-2nd pathology report shows 90% EC , 10% seminoma

        Comment

        • Davepet
          Registered User
          • Mar 2010
          • 4459
          #5
          Good, please let us know how well it works for you.

          Dave
          Last edited by Davepet; 11-22-17, 10:41 PM.
          Jan, 1975: Right I/O, followed by RPLND
          Dec, 2009: Left I/O, followed by 3xBEP

          Comment

          • mcintoda
            Registered User
            • Nov 2016
            • 149
            #6
            Hi Dave,
            It actually worked quite well. I used it now for 2 months. My testosterone almost doubled and the T/E ratio stayed about 10.

            I did have a short window where libido dropped to zero and I didn't feel well. I can only guess my T/E ratio was not good at that time.

            I feel much more energized and have retained/put on muscle despite not being able to work out due to travel and having a cold.
            Age 31 - Portland, OR
            01NOV16- Pain in right testicle, palpable mass
            13NOV16- R I/O. Markers normal
            27NOV16- Stage Ia non-seminoma, 1.3cm, 100% EC, no LVI
            06DEC16 - CT scan clear
            09DEC16 - Started 1xBEP. Neutropenic at day 15; Worst part for me was bleo (allergic).
            03JAN17- Ended 1xBEP; start surveillance
            18MAR17-2nd pathology report shows 90% EC , 10% seminoma

            Comment

            • Mike
              Administrator
              • Apr 2008
              • 973
              #7
              Originally posted by mcintoda View Post
              I asked my doctor to resubmit under different code and the insurance approved it in the end. Just FYI

              That is great information to know. I have a feeling that it was one of those knee-slap rejections. Aren't insurance companies grand at time. haha.

              Glad to hear that it is working for you.

              Mike
              Oct. 2005 felt lump but waited over 7 months.
              06.15.06 "You have Cancer"
              06.26.06 Left I/O
              06.29.06 Personal Cancer Diagnosis Date: Got my own pathology report from medical records.
              06.30.06 It's Official - Stage I Seminoma
              Surveillance...
              Founded the Testicular Cancer Society
              6.29.13 Summited Mt. Kilimanjaro for 7th Cancerversary

              For some reason I do not get notices of private messages on here so please feel free to email me directly at [email protected] if you would like to chat privately so as to avoid any delays.

              Comment

              • Trekga
                Registered User
                • Jan 2017
                • 882
                #8
                Glad you were able to get it approved and that you are feeling better!
                Son Grant
                dx 12/21/16 at age 17
                BEP x3
                Post Chemo CT Scan on 3/28/17 still showed a few nodes over 2 cm
                2nd Post Chemo CT Scan on 4/27/17 showed all nodes still over 2cm
                Post Chemo RPLND 5/8/17: Periaortic Teratoma, Intraaorticaval Teratoma, and Paracaval Teratoma found.

                Comment

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