Menopause Therapy Access Limited by Stigma, Coverage Barriers

In an interview at the Academy of Managed Care Pharmacy Nexus 2026 meeting, Crescent Moore, PharmD, PhD, senior vice president of clinical strategy and product at LucyRx, and a panelist during the “Integrating Perimenopause and Menopause Care into the Pharmacy Benefit: A Managed Care Framework for Improving Women's Health Outcomes” session, described barriers to menopause therapy access as twofold, beginning before a prescription is ever written.

Women face a fragmented health care system when seeking these therapies, Moore said. The first hurdle is finding a physician or nurse practitioner who understands their needs and can prescribe treatment. Because perimenopause and menopause symptoms span multiple body systems and can include brain fog, migraines, and weight gain, patients may also need to see several physicians who do not realize they are all caring for the same patient.

Additional barriers arise on the pharmacy side. Moore noted that formulary coverage can be an obstacle, as can a therapy’s placement on the formulary and the utilization management edits that apply. Much of the challenge comes down to education, she said. Historically, these therapies were not widely covered under the pharmacy benefit, if they were covered at all. As a result, both physicians and patients assumed coverage would be denied and stopped trying. Education about which therapies are covered, what is included in a member's benefit, and perimenopause and menopause more broadly is key, she said.

Moore also pointed to stigma. Reflecting on the generations that came before her, she said menopause long went undiscussed.

“Women really suffered in silence,” Moore said.

Hot flashes, brain fog, and no longer feeling like themselves were viewed as inevitable parts of aging. This stigma affected whether women even brought their symptoms to their physicians, she explained.

From a health equity standpoint, Moore noted that menopause is still not a dedicated part of medical, nursing, or pharmacy school curricula. As a result, providers with additional training or certifications in menopause care can be harder to find. Menopause is not a chronic disease state, but it shares many characteristics of one, she said.

“If a woman just has poor health care access in general, this is just going to be another piece that falls [by] the wayside,” Moore concluded.