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Insurance Co. Disclosed to Employer
Jun 2, 2001

I read through previous answers and I don't think anyone has had this weird situation happen. As many HIV+ males, I have low testosterone and have been receiving semi-monthly shots which help greatly, but are inconvenient and painful. The shots were covered by my insurance without question. A new form of self-administered testosterone gel came out this summer, and my doctor switched me to that.

My company is self-insured and has its prescription program administered by a large mail order pharmacy company. At first, the mail order pharmacy said testosterone wasn't covered. I went to an HR person at my company and asked for help. She told me she needed to know the name of the drug, but promised she wouldn't know what it was and wouldn't try to find out. I told her the brand name, but nothing else.

I met with her again, and she told me that the mail order pharmacy had told her that it was a steroid used and abused by body builders to boost athletic performance and as such was a controlled substance. The mail order pharmacy asked the HR person whether I was a body builder looking for illegal steroids (I'm in decent shape, but I'm no body builder!). She then asked me if I was using the drug legally. I told her that first of all, it was a gel, not something I shot up before working out, and that it was needed because of a more serious underlying condition.

I called a head pharmacist at the mail order pharmacy to complain and he seemed pretty horrified that they had called my employer's HR person. He acknowledged that testosterone replacement was appropriate in HIV treatment and that even if I wanted to, I probably couldn't abuse testosterone in the new gel form.

I feel really embarassed over this whole thing, bascially being asked by an HR person at work whether I abused drugs! Did the pharmacy have the right to discuss it with the HR person without my consent? Did the HR person have the right to bring it up with me?

Thanks for this very important forum and your always helpful answers.

Response from Ms. Franzoi

Often times specific drugs are exclude from coverage from a plan, such as Retin-A, unless it is precribed for a teenager or if over age 20, the doctor verifies that it is for acne treatment and not for wrinkles. What should've happened in this case is the pharmacist should've contacted the physician to determine the reason for the prescription and then based on that made a determination on whether or not the drug shoul be covered. The only time the HR or benefits person should be involved would be if it were denied and you filed an appeal. Although I feel the HR person's question to you was inappropriate, I am going to refer this part of the question on to someone else.

Self-Insured Plans and Disclosure
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