Insights
Hormone therapy and BHRT
Pellets, testosterone, telehealth prescribing, and what each of them changes about how a practice is underwritten.
Why it reads differently
Hormone therapy is not an aesthetic risk
It gets grouped with aesthetics because the same practices often offer both. Underwriting treats it as a different animal, and for three structural reasons.
It is a long relationship
Aesthetic work is episodic. Hormone therapy is ongoing care with monitoring obligations, which means a longer tail and more points at which something can be missed.
The product is often compounded
Which brings sourcing, the compounding pharmacy's own standing, and documentation of both into the file.
Pellet insertion is a procedure
Not a prescription. It has a site, a technique, a training record and an infection risk, and it is underwritten as a procedure.
Pellets
The questions that come up every time
What a submission is asked for
- Who performs the insertion, and their credential.
- What training they completed, from whom, and when.
- Whether insertion is delegated, and if so the written supervision protocol.
- Sourcing for the pellets, including the pharmacy and its registration.
- The follow up protocol, including how site complications are handled and documented.
Telehealth prescribing
Three things that are usually asked together
Where the patient is physically located at the time of the visit, which is the state whose rules apply, and not the state the practice sits in.
Which states each prescriber holds an active license in, kept as a current list rather than reconstructed when asked.
How the initial evaluation is conducted and documented when it happens remotely, and what triggers an in person visit.
Practices expanding across state lines tend to add patients faster than they add licenses. That gap is visible in a submission and it is the thing most likely to slow one down.
What to keep current
The file that makes a renewal routine
Keep these where you can produce them in a day
- Prescriber roster with every state license and its expiry.
- Compounding pharmacy details and current registration status.
- Lab and monitoring protocol, written.
- Consent forms specific to hormone therapy, not borrowed from the aesthetic side.
- Your telehealth policy, including which states you treat in.
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