Merge branch 'main' into gh-pages

_posts/2024-10-08-trapdoor.md

@@ -27,8 +27,8 @@ It's not.
 
 <figure>
   <picture>
-    <source srcset="/assets/img/2024/10/PXL_20231206_190049619.avif">
-    <source srcset="/assets/img/2024/10/PXL_20231206_190049619.webp">
+    <source srcset="/assets/img/2024/10/PXL_20231206_190049619.avif" />
+    <source srcset="/assets/img/2024/10/PXL_20231206_190049619.webp" />
     <img src="/assets/img/2024/10/PXL_20231206_190049619.jpg" alt="A modular video wall with exposed controllers" />
   </picture>
   <figcaption>Jessica Rodriguez, 2023</figcaption>

_posts/2024-12-26-estradiol-injections-insurance.md

@@ -0,0 +1,84 @@
+---
+title: "Getting estradiol injections covered by insurance in Canada 🏳️‍⚧️💉🇨🇦"
+date: 2024-12-26
+excerpt: "Insurance coverage? For my injections? It's more likely than you think!"
+redirect_from:
+  - /blog/2024-12-estradiol-injections-insurance
+---
+
+
+For a few months, I've been getting my HRT via injections, specifically estradiol valerate. It's another option, like
+pills, patches, gels, and [implants](https://www.youtube.com/watch?v=9O7kNmpT_TA), which some people find better suits
+their situation, myself included. However, getting insurance coverage can be challenging, and I've heard many people,
+online and in-person, say it's not possible.
+
+Today, I'm dispelling that rumour. For the last 3 months, I've gotten my prescriptions in Ontario consistently covered
+by Manulife. Here's my most recent claim at the time of writing:
+
+<picture>
+  <source srcset="/assets/img/2024/12/insurance-claim-estradiol-covered.avif" />
+  <source srcset="/assets/img/2024/12/insurance-claim-estradiol-covered.webp" />
+  <img src="/assets/img/2024/12/insurance-claim-estradiol-covered.png" alt="Manulife insurance statement for November 28, 2024, showing 100% coverage for estradiol valerate, at $87.99" />
+</picture>
+<br>
+I'm sharing what I've learned, in the hopes that others will find success.
+
+## Background
+
+So, first we need to understand why it's so tricky to get estradiol injections in Canada.
+
+The only form that's approved is estradiol valerate. This was previously imported as brand-name Delestrogen
+([DIN 00029238](https://health-products.canada.ca/dpd-bdpp/info?lang=eng&code=517)) by the now-defunct Theramed Corporation
+until 2008, and a generic was available from Pharmascience until 2016 ([DIN 00741930](https://health-products.canada.ca/dpd-bdpp/info?lang=eng&code=9615)).
+Since then, there's no way to purchase the commercially-manufactured version, so it has to be compounded by a pharmacy.
+
+And this is where the problem arises. Compounded drugs don't have their own DIN, so when you file an insurance claim,
+the company doesn't recognize the prescription and denies it. Some compounded drugs instead have a _pseudo-DIN_, which
+isn't registered with Health Canada, but the insurance companies recognize when processing claims. Unfortunately,
+estradiol valerate doesn't have a pseudo-DIN. So, the challenge lies in translating the compounded drug to something
+they can recognize.
+
+## What to do
+
+Before doing anything else, check if your provincial or territorial insurance already covers injections. It's unlikely,
+but will save you a lot of stress if it is. For example, estradiol pills are covered under the [Ontario Drug Benefit](https://www.ontario.ca/page/get-coverage-prescription-drugs),
+but not injections, so I had to work with my group plan.
+
+**Your best chance of success is by filing a standard claim with a Drug Insurance Number (DIN).** I talked to Manulife's
+live chat[^1], and they recommended uploading the receipt for compounded drugs, but these got rejected half of the time.
+Still, it might be worth contacting the company and trying what they suggest. Don't worry about resubmitting; I had to
+try 4 times with one receipt and never ran into any issues.
+
+Here's how to find the right DIN:
+
+1. Check the _DIN provided on your prescription receipt_ ([here's an example](https://www.rbcinsurance.com/group-benefits/_assets-custom/popups/understanding-prescription-drug-receipts.html)).
+   If it's something like all zeroes or repeating digits, it's probably a placeholder and won't work. But otherwise, try using this first.
+2. Ask your pharmacy for the _pseudo-DIN of the base "active" ingredient, estradiol_. Your insurance may recognize this number in the claim.
+3. Finally, _search for "\<INSURANCE COMPANY\> pseudo-DIN" and look for a chart of pseudo-DINs_. Then, look for estradiol in the list.
+
+Once you have the DIN, plug this into the claim details. When it asks for the quantity, use something that makes sense.
+Typically, estradiol valerate is compounded in Canada at a concentration of 10 mg/mL. So if you have a 5 mL vial, you
+could put the quantity as "5 mL" or "50 mg" (concentration times volume). If you have a different concentration, you
+should convert to milligrams and use that value, to make sure you receive the correct coverage.
+
+## What worked for me
+
+My pharmacy provided me with pseudo-DIN `00986496` for the base ingredient. It also appears in an [Express Scripts chart](https://www.express-scripts.ca/sites/default/files/2020-12/PSEUDO%20DIN%20COMPOUND%20LIST_v2.0_EN.pdf)
+under the name ESTRADIOL USP MICRONIZED. Using this, Manulife approved the claim and reimbursed me! Some findings:
+
+- I've always filed my claims in mL. I'm not sure what results look like with mg.
+- I originally had my estradiol compounded at my regular pharmacy. I got 2 mL for \$84.14 (or \$42.07/mL), plus an
+  \$11.99 dispensing fee. Manulife inconsistently reimbursed me for the full amount, but it was always a struggle.
+- When I switched to my current method, they only covered \$59.95. Subtracting the dispensing fee, this suggests
+  _Manulife will cover at a rate of \$23.98/mL_.
+- After this, I switched to [Pace Pharmacy](https://pacepharmacy.com/). They compound 5 mL vials for \$38, or \$7.60/mL.
+  Even with the $11.99 dispensing fee, Manulife can now cover the full amount.
+
+## It's possible!
+
+Hopefully this will help you find success, or at least increase your options. If you found this helpful, or know someone
+that this could assist, share the word!
+
+[^1]: I actually really like Manulife's [live chat](https://www.manulife.ca/personal/support/contact-us.html) option,
+      they've been very responsive and helpful every time I've talked to them. I just wish I could access it through the
+      website, and not their subpar mobile app.