PrimeLife Clinic

As a hormone specialist, I have become increasingly concerned about changes I am seeing in access to menopausal hormone therapy.

In 2025, I generally was not required to submit prior authorizations for estrogen or progesterone for my patients. In 2026, I have encountered several insurance companies requiring prior authorization before they will provide coverage for certain estrogen and/or progesterone therapies.

At the same time, I am seeing lower reimbursement and more restrictive coverage for some hormone therapies. There are also documented supply constraints affecting certain FDA-approved estradiol products.

This raises an important question: Are we creating unnecessary barriers between women and evidence-based hormone therapy?

Prior authorization is intended to serve a clinical and cost-management function, but when a physician must repeatedly justify a medication that was previously covered without authorization, it adds administrative burden and can delay treatment.

I am particularly concerned when coverage decisions appear to be driven primarily by formulary or utilization-management processes rather than an individualized clinician-patient assessment.

I am not suggesting that every insurance change has the same explanation, nor that every patient should receive hormone therapy. But the changes I am seeing deserve scrutiny.

Women, clinicians, insurers, and policymakers should be asking:

• Why do estradiol and progesterone therapies now require prior authorization that did not require it previously?

• What clinical criteria are insurers using to approve or deny them?

• Have reimbursement and formulary changes disproportionately affected menopausal hormone therapy?

• Are patients being steered toward particular products for clinical reasons, cost reasons, or both?

• Why add administrative requirements which create barriers to appropriate treatment?

These questions deserve transparent, evidence-based answers.

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