"Private means you pay for everything."
The bill has three parts. They're paid differently.
"HRT" sounds like one thing you either get covered or don't. In practice there are three separate costs: the visit where someone assesses you and prescribes, the bloodwork, and the medication itself. OHIP and Ontario's public drug programs treat each one differently.
| Part | Who usually pays |
|---|---|
| The visit | Depends on who you see and how they bill. |
| Bloodwork | Usually your Ontario health card, when it's ordered with a clinician's requisition and done at a collection centre. |
| Medication | A public plan only at 65+ or 24 and under. Otherwise your workplace drug plan, or you, at the pharmacy. |
No referral needed to book with us.
Medication: it comes down to your age
Ontario runs two public drug programs. Most people looking for menopause hormone therapy sit between them, which is why the medication is the part people are most often surprised to pay for.
The Ontario Drug Benefit program covers eligible prescriptions for Ontario residents 65 and older.
No public drug program by age. You claim through a workplace or private drug plan, or pay at the pharmacy.
OHIP+ covers eligible prescriptions for people 24 and under who don't have a private plan.
Source: Government of Ontario, Ontario Drug Benefit program and OHIP+ eligibility.
Bloodwork: usually covered
If the Nurse Practitioner orders bloodwork, you get a requisition and go to a community collection centre near you with your health card. That testing is usually covered by OHIP. We only order it when the result will change a decision, and we tell you what each test is for.
Saliva hormone panels sold to "balance" hormones are a different thing. The Endocrine Society says claims that saliva tests can customise hormone doses lack supporting data, so we don't use them.
Source: Endocrine Society, position on compounded bioidentical hormone therapy (2019).
The visit: ask before you book
Whether a visit is billed to OHIP depends on who you see and how their practice is set up. Ask before the appointment, and get the answer in writing.
If you have a Health Spending Account, check whether it reimburses nurse practitioner visits. Ask for an itemised receipt.
Not sure it's hormones at all? Start with what's actually happening.
Does BHRT change the answer?
Not for body-identical hormones. "Bioidentical" describes a hormone with the same structure as the one your body makes, and the SOGC notes these are available in Health Canada approved prescription products. Custom-compounded "BHRT" is different: it isn't Health Canada approved, so ask your drug plan how it treats compounded products before you assume they're covered. Either way, bioidentical doesn't mean natural or safer.
Source: SOGC, Menopause and U, "Bioidentical hormone therapy".
Five questions to ask your drug plan
- Does my plan cover prescription hormone therapy for menopause?
- Is there a deductible, a co-pay or a cap on dispensing fees?
- Do I need prior authorisation before the first fill?
- Does my Health Spending Account reimburse nurse practitioner visits?
- What do you need on the receipt for a claim?
Sources
- Government of Ontario, Ontario Drug Benefit program and OHIP+ eligibility: ontario.ca/drugbenefit and ontario.ca/page/check-medication-coverage.
- SOGC, Menopause and U, "Bioidentical hormone therapy": menopauseandu.ca.
- Endocrine Society, position on compounded bioidentical hormone therapy (reissued 2019).
This page is general information, not advice about your own coverage. Your plan's answer is the one that counts.