HRT Cost: Hormone Replacement Therapy Pricing Explained
Key takeaways:
Hormone replacement therapy (HRT) is a common menopause treatment that uses estrogen products.
Prices can range from $10 a month for a 90-day supply of generic estrogen tablets to more than $500 for a 90-day vaginal ring.
Most insurance plans cover estrogen products, but your out-of-pocket costs may be high. You may be eligible for savings through manufacturer discounts and patient assistance programs.
Hormone replacement therapy (HRT) can refer to treatments using estrogen or testosterone. In this story, we will focus on estrogen replacement therapy taken during menopause.
For most people, menopause starts between ages 40 and 58. During this season of life, hormone levels begin to change. During and after menopause, your body makes less estrogen and progesterone than it did before. Because of this, many women experience symptoms such as:
Hot flashes
Night sweats
Mood changes
Vaginal dryness
Is MHT safe? Research has widely debunked the claim that menopausal hormone therapy (MHT) increases your risk of diseases like breast cancer. But this treatment isn’t for everyone. Learn about the pros, cons, and who should avoid MHT.
Affordable menopause treatments: Find out how to save on some of the most popular treatments that will help you manage your menopause symptoms.
Stopping MHT: MHT can help you get a handle on the uncomfortable symptoms of menopause, but it isn’t for long-term use. Here are some ways to safely navigate the transition.
HRT can help to treat these symptoms.
Common treatments contain estrogen and estrogen/progestin combinations. These medications may come several forms, including:
Creams
Gels
Injections
Patches
Tablets
Vaginal suppositories
Vaginal rings
Let’s discuss the cost of different types of prescription HRT.
How much is hormone replacement therapy?
The cost of HRT varies depending on the form of estrogen you’re taking and what kind of insurance coverage you have. Let’s explore prices for commonly used HRT treatments and potential savings from manufacturers.
Creams
There are two main estrogen creams for vaginal dryness and pain during sex: Premarin and Estrace.
Premarin, which is only available as a brand-name medication, can cost more than $400 for one tube of cream. The average cash price is $26.76. Eligible consumers may pay as little as $25 per tube with this manufacturer savings card.
Estrace has a generic option (estradiol) and typically costs less than Premarin. With GoodRx, the average cash price of one tube of generic Estrace cream is $129.73. The manufacturer also has a patient assistance program for brand-name Estrace, which can help you access the topical treatment for free.
Gels
Estradiol gel comes in several formulations that are used different ways:
Divigel is sold in packets for application on the thigh and it comes in both generic and brand-name versions. A carton of 30 packets can cost less than $40 with GoodRx. The average cash price for that supply of 0.5 mg gel is $181.48.
Elestrin is a brand-only medication applied to the upper arm. A package of 2 gel pumps can cost around $260 with GoodRx. The average cash price for that supply of 35g pumps is $310.98. If you have commercial insurance, you may qualify to use the Elestrin savings card for up to $25 off each prescription. The PAN Foundation’s patient assistance program includes Elestrin for postmenopausal osteoarthritis.
EstroGel is a brand-name medication applied to the entire arm. At certain pharmacies, 1 pump may cost as low as $175.04 with GoodRx. The average cash price is $201.31 for 1 pump. The PAN Foundation’s patient assistance program includes EstroGel for postmenopausal osteoarthritis.
Injections
There are several estrogen injections that treat menopause symptoms. They include:
Delestrogen has a generic option that can cost you less than $50 with a GoodRx coupon. The average cash price is $150.74 for a single 20mg/ml strength vial.
Depo-Estradiol is available only as a brand-name medication. With GoodRx, this once-a-month injection can cost less than $180. The average cash price for 1 vial is $258.88. If you don’t have insurance, you may be eligible for Pfizer Rx Pathways, the maker’s patient assistance program.
Patches
There are about a dozen estrogen patch brands. They typically fall into 2 categories: once-a-week and twice-a-week. Here are some pricing samples:
The generic Estradiol patch comes in various dosages packaged in cartons of 4 weekly patches or 8 twice-weekly patches. With GoodRx, a monthly carton of any dosage or frequency can cost less than $40.
Climara is available as a brand name or generic once-a-week patch at various dosages. With GoodRx, you can pay around $20 a month for a month’s supply of 0.05 mg patches. The average cash price for that supply is $66.43.
Climara Pro is only available as a brand-name patch. Like Climara, this patch contains estradiol. But Climara Pro also contains levonorgestrel, a progestin (a form of progesterone). With GoodRx, you can pay around $250 a month for a package of 4 weekly patches. The average cash price you pay for that supply is $317.49. Also, Bayer offers a savings card for Climara Pro that can reduce your out-of–pocket costs. You also may be able to get help paying for these patches through the Bayer U.S. Patient Assistance Foundation.
Menostar is available as a brand name only. With GoodRx, you can pay around $180 or less for 4 once-a-week patches. The average cash price for 1 package of 4 patches is $. You may be able to get help paying for this HRT through the Bayer U.S. Patient Assistance Foundation.
Vivelle-Dot is a twice-weekly patch available as a brand-name medication and a generic. The generic carton of 8 patches can cost around $30 with GoodRx. The brand name’s average cash price for 8 patches at the 0.05 mg strength is $88.80.
Tablets
Some people prefer oral medication for HRT. Here are some options:
Estrace is the most common oral estrogen medication. These tablets are available in generic and brand-name versions. You could pay $10 or less for a generic 90-day supply with GoodRx, depending on the dosage. A 3-month supply of brand-name medication can cost $500 or more.
Premarin is available not only as a cream but also as a brand-name tablet in 5 dosages. You could pay less than $200 for a 30-day supply of the middle dosage, 0.625 mg. The average cash price for a 30-day supply of that dosage is $268.58. With Pfizer's savings card for Premarin tablets, you may pay as little as $25 per prescription. A patient assistance program is also available for those who meet certain financial eligibility requirements.
Vaginal suppositories
Estrogen suppositories are placed in the vagina. They can help with vaginal dryness and pain during sex. Here are some options:
Vagifem is a vaginal tablet containing estradiol. This medication is available in generic and brand-name versions. Available in several quantities, a generic 8-pack can cost less than $40 with GoodRx. The brand name’s average cash price is $144.19 for the same quantity.
Imvexxy is a vaginal insert in the form of a softgel capsule available in a brand-name version only. Anyone with a valid prescription, regardless of insurance status, can use GoodRx to purchase 8 inserts of Imvexxy at an exclusive cash price of $85. The brand name’s average cash price for 10 mcg 8-pack is $267.39. With the manufacturer savings card for people with commercial insurance, you can pay as little as $35.
Vaginal rings
Estrogen rings are inserted in the upper part of the vagina for 90 days at a time. Here are 2 popular options, which are available only in name brands:
Estring provides a low dose of estrogen (0.0075 mg per day). It may be useful if you have vaginal or urinary symptoms related to menopause. Anyone with a valid prescription, regardless of insurance status, can use GoodRx to purchase a 3-month supply (1 ring) of Estring at an exclusive cash price of $249. The average cash price for 1 ring is $636.16. If you have commercial insurance, you may be eligible to pay as little as $25 for Estring using a savings card from the manufacturer. A patient assistance program is also available for those who meet certain financial eligibility requirements.
Femring offers a higher dose of estrogen in 2 doses (0.05 mg per day and 0.1 mg per day). This ring can be used to treat vaginal and urinary symptoms as well as hot flashes and night sweats. With GoodRx, you can pay about $500 for the 0.05 mg ring and about $700 for the 0.1 mg ring. The average cash price for a 0.05 mg ring is $937.67 and $1001.82 for a 0.1 mg ring. With the manufacturer copay savings card for people with commercial insurance, you could pay as little as $25 per ring.
Is estrogen covered by insurance?
Most people with health insurance are covered for HRT.
More than 90% of Medicare and Medicaid plans cover estradiol, the most common form of HRT. That figure rises to 99% for commercial insurance plans. HRT is covered by Tricare.
Insurance coverage doesn’t mean good coverage
Having insurance coverage doesn’t necessarily make HRT medications affordable. Although many insurance plans include estradiol products in their formularies, they often place these medications in higher tiers, which have the highest copays. These high out-of-pocket costs are most common with brand-name HRT.
Some brand-name HRT treatments have manufacturer discounts that can help you with your copay if you have insurance and the overall cost of the medication whether you have insurance or not.
As mentioned earlier, Pfizer offers a savings card for Premarin tablets. You cannot qualify for the discount if you are enrolled in a state and federally funded insurance plan, even if you self-pay for the medication. If you don’t have insurance, you may be eligible for Pfizer RxPathways, the company’s patient assistance program (PAP).
Abbvie, the manufacturer of the Estrace vaginal cream, has a PAP that can help you access the topical treatment for free.
Check with the manufacturer of a HRT medication to see if there is a saving card or patient assistance program that can help you access the treatment for less. You can also talk to your healthcare provider about less costly alternatives or getting medication samples.
Can you get HRT without seeing a healthcare provider?
Prescription HRT is only available through a visit with a healthcare provider. There are over-the-counter (OTC) or natural treatments available, but these products don’t have much evidence to support their use and shouldn’t be considered substitutes for prescription medications.
Your healthcare provider may have estrogen creams available to buy in their office. Also, OTC vaginal lubricants may offer non-hormonal relief for vaginal dryness.
The bottom line
Hormone replacement therapy can have a range of price points, depending on the estrogen delivery system. Estrogen treatments include creams, gels, injections, and more.
Prices can range from $10 a month for a 90-day supply of generic estrogen tablets to more than $500 for a 90-day vaginal ring. Most insurance plans cover some form of estradiol, the most common form of HRT. However, your HRT prescription may have high out-of-pocket costs even if you have insurance. Check online for manufacturer savings, such as copay discount cards and patient assistance programs. You should also talk to your healthcare provider about less costly alternatives and medication samples.
Why trust our experts?
This article is solely for informational purposes. This article is not professional advice concerning insurance, financial, accounting, tax, or legal matters. All content herein is provided “as is” without any representations or warranties, express or implied. Always consult an appropriate professional when you have specific questions about any insurance, financial, or legal matter.
