HRT in Missouri: 2026 Prices, Online Providers and What Anthem or MO HealthNet Will Pay

Updated October 13, 2026. That day we read Missouri's telehealth statutes as amended in 2026, the Board of Nursing's collaborative practice rule, Anthem's 2026 Missouri drug list and MO HealthNet's drug rules. Every service price comes from the provider's own listing within the past three weeks. Coupon prices are GoodRx national figures.

In a hurry? Match your situation below, then find that provider in the table above.

• Cheapest start: Winona, from about $40 a month for one product, with no consult fee.
• A fee that halves: Inner Balance, about $100 a month from month seven.
• An Aetna, Blue Cross, Cigna or UnitedHealthcare plan: Midi Health, which bills your plan for the visit.
• A low-cost membership with messaging: Evernow, about $35 a month on a prepaid year, with medicine extra.
• A Menopause Society-certified doctor: Alloy, from about $40 a month after a one-time $49 consult.
• Already have a prescriber: coupon generics, or The HRT Club.
• On MO HealthNet: a clinician who takes your MO HealthNet health plan, since none of these online services does.

HRT in Missouri: what hormone replacement therapy costs and who serves the state

Missouri doesn't change what these services charge. It changes the rules behind the visit: what an online intake must cover, who may prescribe, and what plans must pay.

There are three ways to pay. Subscriptions fold the visit and the medicine into one monthly charge. Insurance-billing and membership services charge for the care, then send your prescription to a pharmacy. Coupon generics cost the least, but only once someone has written the prescription.

Winona: best for a low first bill and no bloodwork

Missouri is on Winona's list of 37 states, which also includes Puerto Rico. You pay per product, with no consult fee and no bloodwork. Progesterone capsules alone cost about $40 a month. The estradiol patch costs the most, at about $150.

The patch, tablets and capsules are FDA-approved. The creams are compounded, meaning mixed to order, in pharmacies Winona owns. You can pay with an HSA or FSA card. Those are tax-free health accounts that many employers offer. Winona doesn't take insurance.

Winona rates 4.6 on Trustpilot from about 8,600 reviews. Complaints mostly involve automatic refills and cancelling. There's no video visit and no testosterone. Our Winona review shows how to cancel cleanly.

Inner Balance: best for a fee that halves after six months

Inner Balance costs about $200 a month for the first six months. That price covers the evaluation and Oestra, its only treatment. Oestra is one compounded cream that holds estradiol and progesterone. You apply it vaginally, and it works on the whole body. From month seven, the fee falls to about $100. Labs are optional.

Its review record is thin, at 2.3 on Trustpilot from 32 reviews. Most complaints concern cancelling, and a dose change may cost extra. The refund promise has two deadlines, explained in our Inner Balance review.

Alloy: best for Menopause Society-certified doctors

Alloy treats menopause in all 50 states and DC. You pay a one-time $49 consult, then a price for each product, with no membership. Every prescribing doctor is certified by The Menopause Society, the leading US medical group for menopause care.

The estradiol pill is its cheapest estrogen, at about $40 a month. Patches ship and bill every three months, so the charge lands once a quarter. On a first order, code PILL25 takes 25 percent off the pill, and HRT25 does the same for Evamist spray.

Care happens by message, with no video and no labs. Alloy rates 4.3 on Trustpilot from about 3,990 reviews. Our Alloy review covers the rest.

Midi Health: best if you want your plan to pay for visits

A PPO, or preferred provider organization, is a plan that lets you see specialists without a referral. Midi says it's in-network with most PPO plans. In network, you pay your specialist copay, a set fee per visit, plus any deductible you haven't met yet.

Midi's Missouri page names Aetna, Blue Cross Blue Shield, Cigna and UnitedHealthcare. Out of network or uninsured, the first visit costs $250 and each follow-up costs $150.

All four Missouri clinicians Midi shows are nurse practitioners. The page names Kansas City, St. Louis, Springfield, Columbia, Independence and Lee's Summit. Visits are by video, prescriptions go to your local pharmacy, and labs are billed separately.

Midi rates 4.1 on Trustpilot from about 1,700 reviews. Midi Health and insurance goes plan by plan.

Evernow: best for a low-cost membership with messaging

Evernow treats menopause only and says it serves all 50 states plus DC. The membership costs $49 month to month, $129 for three months, or $420 for a year paid upfront. The yearly plan works out to about $35 a month.

Membership covers round-the-clock messaging with a clinician, prescriptions and refills. Video visits are extra. Evernow bills them to the insurers it names nationally: Blue Cross Blue Shield, Anthem, UnitedHealthcare and Aetna. Without coverage, a visit costs $150, and medicine is billed separately.

Its estradiol patches and vaginal estradiol cream are FDA-approved. The cream is free on the 3- or 12-month plan if you qualify. A few products, such as a facial estriol cream, are compounded.

The Trustpilot profile is small and unclaimed, at 2.0 from 15 reviews, and its terms set out no general refund policy. Our Midi Health vs Evernow comparison puts the two side by side.

The HRT Club: best if a doctor already prescribes for you

The HRT Club is not a clinic. It's a mail-order pharmacy membership with a free directory of prescribers. The basic tier costs nothing, and membership costs $12 a month or $99 a year.

Members pay $15 for 30 capsules of generic progesterone, against $135 for guests. It fits if a Missouri doctor already writes your prescription and you pay cash to fill it.

The weak spots are no refunds, an annual plan you can't end early, and no Trustpilot reviews yet. Our HRT Club review lists what gets discounted.

Generic estradiol and progesterone at a Missouri pharmacy

With a prescription in hand, a generic with a coupon card usually costs least. The coupon row shows GoodRx national prices, not a quote for a St. Louis or Springfield ZIP code. Your pharmacy may land a little higher or lower.

At those prices, 30 estradiol tablets cost about $15 and a month of patches about $35. A month of micronized progesterone, the body-identical form of the hormone, costs about $15. Without the coupon, it runs about $50.

If you have Anthem or another plan, compare the coupon price with your copay and pay the lower one. The HRT savings guide explains how the cards work.

A year of HRT in Missouri

• Winona, estrogen and progesterone cream: about $1,070 a year. The patch with a progesterone capsule comes to about $2,255.
• Inner Balance: about $1,790 in year one, then about $1,195 a year.
• Alloy, patch and progesterone: about $1,525 in year one with the consult, then about $1,475. The pill with progesterone comes to about $805 in year one.
• Evernow: about $570 for a prepaid year plus one self-pay visit, or about $740 paying monthly. Medicine is extra.
• Midi Health: your specialist copay per visit in network. Paying cash, a first visit and three follow-ups cost $700, with medicine extra.
• Your own prescriber and coupon generics: about $360 a year with tablets and progesterone, up to about $600 with patches, plus visit fees. The HRT Club adds $99 a year if you fill through it.

Is HRT online legal in Missouri, and who can prescribe it?

Yes. Missouri defines telehealth broadly, in section 191.1145. It covers live video, audio-only calls and asynchronous care, where you send your history and a clinician reviews it later.

Before treating you, the clinician must set up a proper patient relationship under section 191.1146. An online visit can do that when the standard of care doesn't call for an in-person exam. The clinician must evaluate you, review your history and examine you as far as diagnosis requires.

Online questionnaires got a clearer place in 2026. Until then, Missouri law said a questionnaire alone couldn't count as the medical interview. House Bill 2372, in force since August 28, 2026, accepts one if it gathers enough to match an in-person evaluation.

That questionnaire comes with conditions. The treating clinician must review it. The clinician must also work for, or contract with, a business licensed to provide health care in Missouri.

You may notice one more step. If you name a primary care doctor, the service must send them a short report within 14 days. It covers the visit date, any diagnosis and the treatment given.

Midi Health and Evernow use video visits. Winona and Alloy start with a written health history that a doctor reviews, then follow up by message. Each one sends an electronic prescription.

A Kansas or Illinois doctor treating you in Missouri

Many women around Kansas City see doctors on the Kansas side, and many in St. Louis cross into Illinois. Section 191.1145 says anyone treating a Missouri patient by telehealth must be fully licensed in Missouri.

What counts is where you are during the visit. An Overland Park doctor without a Missouri license can't keep prescribing by video while you're home in Independence. The law exempts informal consults and one-off consults that your Missouri doctor requests.

Getting that license is easier than it was. Missouri joined the Interstate Medical Licensure Compact through a 2023 law that took effect on August 28, 2023. The compact is a faster licensing route for doctors in member states, and Kansas and Illinois both belong.

Nurse practitioners prescribe under a collaborative practice arrangement

Missouri doesn't give nurse practitioners full independence. Under section 334.104, an advanced practice registered nurse, or APRN, prescribes through a written arrangement with a collaborating physician.

The Board of Nursing's rule sets the checks. The physician reviews at least 10 percent of the APRN's charts every 14 days. When controlled drugs are prescribed, at least 20 percent of those charts get reviewed.

The law also asks physician and nurse to work close enough to collaborate. That proximity rule can be waived when the arrangement spells out the use of telehealth, which matters for online care.

Estradiol and progesterone sit well within that authority. So a nurse-led online visit, like Midi's in Missouri, is legitimate here.

Testosterone follows tighter rules

Testosterone is a Schedule III drug, a federal class of controlled medicines with extra prescribing rules. Prescribing it by telemedicine with no prior in-person exam relies on temporary federal rules that run through December 31, 2026.

Missouri adds its own layer. A prescriber needs a state registration from the Bureau of Narcotics and Dangerous Drugs as well as a federal DEA registration. Pharmacies report controlled-drug fills to the statewide prescription monitoring program, which went live in December 2023.

A nurse practitioner can prescribe it only if the collaborating physician delegates that authority in writing. The Board of Nursing must also grant a controlled-substance certificate.

No testosterone product is FDA-approved for women. The evidence supports it mainly for low sexual desire after menopause. Winona doesn't offer it, and Evernow doesn't list it on its site.

Will Anthem, MO HealthNet or Medicare pay for HRT?

For the medicine, usually yes. For a telehealth membership, no plan pays. Midi and Evernow are the exceptions for visits, because they bill some plans.

Missouri's telehealth coverage law is section 376.1900, in force since 2014. A state-regulated plan can't deny a covered service just because it happens by telehealth. Your deductible and copay can't be higher than for the same visit in person.

The law does let plans limit telehealth coverage to in-network clinicians. Self-funded employer plans, common at large companies, follow a federal law called ERISA instead. Your HR team can tell you which kind you have.

Anthem Blue Cross and Blue Shield

Anthem is the Blue Cross plan for most of Missouri. Blue Cross and Blue Shield of Kansas City, known as Blue KC, covers 30 Missouri counties around Kansas City and in the northwest.

Every plan publishes a formulary, its list of covered drugs sorted into price tiers. Tier 1 is the cheapest tier, and it mostly holds generics.

Anthem's 2026 Missouri Select drug list covers individual marketplace plans and was updated October 1, 2026. It puts generic estradiol tablets on tier 1. Weekly and twice-weekly estradiol patches sit on tier 1 as well, with a quantity limit.

Generic progesterone capsules are tier 1 too. None of these generics needs prior authorization, meaning advance approval from the plan. Brand combination pills cost more, with Prempro and Bijuva on tier 3.

Employer plans may use a different Anthem list, such as the National or Essential drug list. Search yours for estradiol and progesterone in your Anthem account. Our HRT insurance guide explains how to read a formulary and appeal a denial.

MO HealthNet

MO HealthNet is Missouri's Medicaid program. Voters approved expansion as Amendment 2 on August 4, 2020, and the state began enrolling expansion adults on October 1, 2021.

Adults aged 19 to 64 can qualify on income alone, up to 138 percent of the federal poverty level, or FPL. The FPL is a yearly income line set by the federal government. In 2026, the limit works out to about $1,835 a month for one person.

A change starts on January 1, 2027. Most expansion adults will need to show 80 hours a month of work, school, volunteering or a work program. Earning at least the federal minimum wage times 80 in a month also counts.

Several groups are exempt. They include people who are medically frail, parents or caretakers of a child 13 or younger, and family caregivers for someone with a disability. The state must send a written notice before any change to your coverage.

For HRT itself, estrogens and progestins aren't a class on MO HealthNet's preferred drug list, and no clinical edit names them. The program says it pays for all medicines whose makers join the federal rebate program. That includes ordinary generics such as estradiol and progesterone.

None of the online services on this page takes MO HealthNet. You'll need a clinician who accepts your MO HealthNet health plan.

Medicare

Part D drug plans usually cover generic estradiol and progesterone. In 2026, your out-of-pocket costs for covered drugs are capped at $2,100.

Midi treats Medicare as out of network, so you'd pay its self-pay rate for the visit. Evernow doesn't support Medicare coverage either.

Bioidentical hormones and pellets in Missouri

Search for bioidentical hormones in Missouri and many results lead to cash-pay clinics selling creams or pellets. Bioidentical means a hormone shaped exactly like the one your body makes. It doesn't mean compounded.

The estradiol patch and micronized progesterone most services ship are bioidentical and FDA-approved. Compounded hormones are mixed by a pharmacy for one patient and never go through FDA approval.

Missouri's Board of Pharmacy sets two rules worth knowing. First, a pharmacy outside Missouri can't ship prescriptions into the state without a Missouri license. That covers the mail-order pharmacies behind national telehealth brands.

Second, Missouri's compounding rule bars making what is essentially a copy of a commercially available drug. The exception is when the prescriber documents a specific medical need for that patient.

Pellets are small compounded implants placed under the skin every few months. Biote's directory lists certified pellet providers across the St. Louis area. Pellets aren't FDA-approved, so expect to pay cash. Ask for a written quote covering the pellets, insertion and labs, and see our hormone pellets guide before you book.

The FDA asked the National Academies to review compounded bioidentical hormones. Their 2020 report found no strong evidence that they're safe or effective. ACOG and The Menopause Society both favor FDA-approved hormone therapy whenever an approved product exists.

FDA-approved products also carry updated safety labels. In February 2026, the FDA approved the first labels that drop the heart disease, breast cancer and probable dementia statements from the boxed warning, a label's most prominent caution.

On this page, Alloy's core protocol, Midi's default treatments, Evernow's patches and vaginal cream, and the coupon generics are FDA-approved. Winona offers both kinds, and Inner Balance's Oestra cream is compounded. If you want compounded hormones on purpose, compounded HRT: where to get it covers what to check.

Finding a menopause doctor or menopause specialist in person in Missouri

Start with The Menopause Society's online Find a Menopause Practitioner directory. It lists Society members and Menopause Society Certified Practitioners, often shortened to MSCP, and you can search it by location.

In St. Louis, a July 2026 St. Louis Magazine guide points to a WashU Medicine nurse practitioner who holds the MSCP credential. She sees patients at the Barnes-Jewish Center for Outpatient Health on Forest Park Avenue.

On the Kansas City side, University Health offers perimenopause and menopause care at its Women's Care clinic in Lee's Summit.

Outside the big metros, access thins fast. March of Dimes' 2024 report counted 51 percent of Missouri counties as maternity care deserts, with no obstetric clinicians and no birthing hospital. That usually means no local gynecologist for menopause questions either.

That gap is where online care helps most. Midi's Missouri page names Springfield and Columbia among the cities it serves by video, and Winona and Alloy work entirely online.

A local visit adds a physical exam, which no online service on this page offers. Our guide to finding perimenopause care explains how to vet a local clinician. HRT near me covers when an online clinician beats the nearest office.

Starting HRT in Missouri: timing, labs and the questions to ask

Plenty of women in their 40s hear they're too young for hormones. The Menopause Society's 2022 position statement finds benefits outweigh risks for most healthy women with symptoms. That applies under 60, or within ten years of menopause.

Perimenopause comes before that final period, so it falls inside the window. You usually don't need blood tests to start, because hormone levels swing too much to confirm it. Winona and Alloy prescribe on symptoms alone. Perimenopause labs explains what a panel can and can't show.

Before you commit, put these four questions to any Missouri prescriber, online or in an office.

• Training: Are you Menopause Society certified, or trained in menopause care?
• First choice: Do you start with FDA-approved estradiol and micronized progesterone before anything compounded?
• License: Do you hold a Missouri license, even if your office is in Kansas or Illinois?
• Oversight: If you're a nurse practitioner, who is your collaborating physician?

How your dose gets settled after you start is covered in our HRT dosage guide.