Anthem GLP-1 Coverage Guide: Prior Authorization, Step Therapy, and Exclusions

by Dr. Jennifer Frangos, D.O., DABOM | Apr 17, 2026 | Insurance & Coverage, Guide, Guide, Hormone Replacement Therapy

Anthem covers GLP-1 medications like Ozempic, Wegovy, Zepbound, and Mounjaro, but approval is not automatic. Prior authorization is always required, and many plans include step therapy and employer-level exclusions that can block coverage—even when the medication is...

Blue Cross Coverage for Estradiol: When Prior Auth, Step Therapy, or Formulary Rules Apply

by Dr. Jennifer Frangos, D.O., DABOM | Apr 16, 2026 | Insurance & Coverage, Guide, Hormone Replacement Therapy

Blue Cross Blue Shield usually covers FDA-approved estradiol medications, but access often depends on your specific plan’s formulary tier, whether prior authorization is required, and whether step therapy rules apply first. Generic estradiol is usually easier to...

Humana Testosterone Coverage: Prior Authorization Rules and Common Delays

by Dr. Jennifer Frangos, D.O., DABOM | Apr 15, 2026 | Insurance & Coverage, Hormone Replacement Therapy, Testosterone Insurance Appeal Letter, Testosterone Replacement Therapy

Medically reviewed by Dr. Jennifer Frangos, D.O., DABOM — Board-certified physician with over 15 years in hormone optimization and insurance advocacyLast updated: March 2026 Humana usually covers testosterone replacement therapy when there is a confirmed medical...

Medicare and Hormone Therapy Coverage: What Medicare Usually Covers, Restricts, or Excludes

by Dr. Jennifer Frangos, D.O., DABOM | Apr 14, 2026 | Insurance & Coverage, Hormone Replacement Therapy, Testosterone Insurance Appeal Letter, Testosterone Replacement Therapy

Medically reviewed by Dr. Jennifer Frangos, D.O., DABOM — Board-certified physician with over 15 years in hormone optimization and insurance advocacy Last updated: March 2026 Medicare covers hormone therapy only in specific situations. Coverage depends on whether the...

What to Do When Express Scripts Says Your Medication Needs Prior Authorization

by Dr. Jennifer Frangos, D.O., DABOM | Apr 10, 2026 | Insurance & Coverage, Hormone Replacement Therapy

Medically reviewed by Dr. Jennifer Frangos, D.O., DABOM — Board-certified physician with over 15 years in hormone optimization and insurance advocacyLast updated: March 2026 When Express Scripts flags your prescription for prior authorization, it means your medication...

Zepbound Not Covered? What to Check First (Formulary, Prior Auth, or Employer Plan)

by Dr. Jennifer Frangos, D.O., DABOM | Apr 10, 2026 | Insurance & Coverage, Guide, Guide

Medically reviewed by Dr. Jennifer Frangos, D.O., DABOM — board-certified physician with experience in hormone optimization and insurance access supportLast updated: April 2026 If Zepbound is not covered, the reason matters. Most denials fall into four categories:...