Estrogen patch shortages leave Medicare patients facing unexpected costs

Reuters reported on October 28th that the shortages extend beyond estrogen patches, impacting other hormone treatments. The Food and Drug Administration (FDA) is collaborating with all six manufacturers of estradiol patches to increase supply, though it has not formally declared a shortage. Many women are scrambling to find alternatives, adjusting dosages, and switching brands.

Medicare Part D formularies dictate which specific medications are covered and at what cost. The exact formulation, drug name, strength, and prescribed indication all influence coverage and patient expenses. A patch, gel, cream, or injection – all delivering estradiol – may be treated differently by a plan, with varying tiers, prior authorization requirements, or complete exclusion.

Patients should first consult with their pharmacist to explore covered alternatives. These could include different brands or strengths of patches, or a covered gel, potentially incurring only a standard copay. Paying full price should be a last resort.

If no covered options are suitable, a formulary exception can be requested. This requires the prescribing doctor to explain why alternatives are ineffective or potentially harmful. Plans are generally obligated to respond within 72 hours, or 24 hours if immediate health risk exists. Approval isn’t guaranteed, and denials can be appealed. Tiering exceptions may also lower costs for covered, but expensive, medications.

Part D’s out-of-pocket spending cap will be $2,100 in 2026, rising to $2,400 in 2027. This cap only applies to covered drugs; payments for excluded medications don’t count toward the limit unless an exception is approved. This means a patient who has already reached the cap can still face full retail prices for uncovered alternatives.

Open enrollment for Medicare plans concludes on December 7th. Switching plans can require a new exception request, but a 2027 plan that already includes the necessary substitute medication could eliminate this need.

Even with insurance approval, obtaining the medication can be challenging due to ongoing supply issues. Patients should verify availability at multiple in-network pharmacies, including mail-order options, before switching medications. The FDA notes that brand availability can vary by location.

Before making any changes, patients should confirm coverage with their plan, understand the reason for any rejection, and discuss suitable alternatives with their doctor. A strong medical justification from the prescriber is crucial for exception requests. Using Medicare’s Plan Finder to search for 2027 plans that cover the needed medication could also provide a cost-effective solution.