Aetna, CVS Health Expand Transgender Surgery Coverage Offerings

Aetna, a CVS Health company, announced recently that it is updating policies to expand coverage offerings of gender-affirming surgery to include breast augmentation for transfeminine beneficiaries.

This decision stems from a collaboration between the insurer, the Transgender Legal Defense & Education Fund (TLDEF), a national civil rights law firm Cohen Milstein Sellers & Toll, and several transgender beneficiaries.

Previously, Aetna already covered several gender-affirming treatments and surgeries, subject to plan terms and other requirements. However, after being denied coverage for breast augmentation, and with the guidance of TLDEF and Cohen Milstein, several transgender beneficiaries approached Aetna and outlined issues with access to care.

“My hope is that being part of this groundbreaking collaboration helps other transgender and non-binary people have access to the health care we deserve,” said Nancy Menusan, one of the transgender beneficiaries who came forward, in a statement. “By dropping exclusions for medically-necessary care like top surgery, Aetna is paving the way and setting an example for other health insurance providers, and I hope others will take note.”

Aetna explained in a statement that the insurer will “consider breast augmentation medically necessary rather than cosmetic for transgender members who meet certain criteria, including a letter of referral from a qualified mental health professional; persistent, well-documented gender dysphoria; and the completion of one year of feminizing hormone therapy prior to breast augmentation surgery.”

“Our decision to update our clinical policy bulletin is consistent with many changes we have made over the years to better serve the needs of the LGBTQ community,” said Jordan Pritzker, MD, senior director of clinical solutions for Aetna. “We appreciate the collaborative nature of this process, which allowed us to make an evidence-based change to our coverage policies regarding important care for members of the LGBTQ community.” —Edan Stanley