IVF Stimulation Medication
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Anonymous
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I just wanted to share my story and how it pays to call around for your IVF Stimulation Medication.
I recently changed plans to CareFirst BluePreferred PPO Gold through MD Health Connection because my employer is based out of DC. I did it for the IVF coverage but knew most insurance would not cover IVF medication coverage. I'm with Shady Grove and I used Village Fertility for my IUI medication. My quote from VF was $5,995 but my lowest quote was from MDR for $5,426 (I'm 37 so my medication is dosage is high). MDR does use other brands of medications (for example Follistim instead of Gonal F), but my nurse said that was fine. I gave my insurance information to 6 pharmacies for them to see if my insurance would cover the medication. I knew it most likely would not but it didn't hurt. Most came back saying that the oral pills were covered but not the injectables (which were the most expensive). I got a call from Encompass RX and somehow they got my injections covered! They said out of packet was $450. From what I understand, my insurance needed pre-authorization and I guess Encompass RX was able to go through the correct channels to get my medication approved. I'm a little apprehensive to celebrate until I get my medication. Anyone else have their medication covered? |
Anonymous
| The Maryland Exchange plans typically cover IVF medicines. the one exception I've seen is UHC. |
Anonymous
Oh, that's great! I'm surprised that the other 5 pharmacies before Encompass told me that my insurance did not approve the injectables. |
Anonymous
| You sometimes have to go to the approved pharmacy or ask for the right stim med (Gonal vs. Follistim). I've had drugs covered under BCBS and Kaiser. |
Anonymous
| Hi OP. I have the exact same plan as you and just started with it this month for IVF. My fertility clinic (not SGF) told me that I HAD to use CVS Specialty pharmacy. I also called the insurance myself and was told the same thing, because I wanted to use Ambulatory Care pharmacy that's in the same building as SGF. So based on what I've been told, I'm really surprised that Encompass pharmacy worked for you, but that's great that it did. The process for pre-authorizations that I've just been through with this plan is that my clinic submitted for pre-auth for the IVF procedure. That came through, then the insurance needed more time to do pre-auth for the IVF drugs. Strange coincidence that my copay for upcoming IVF stim cycle drugs is the same as yours ($450). |
Anonymous
Encompass RX is part of CVS pharmacy. SGF never told me that they had to submit a pre-authorization. When I questioned it before, they said I had to call the pharmacy to ask for prices. Hmph... luckily I ended up calling Encompass or I would of paid $5,000 more! |
Anonymous
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One factor to consider, OP, is whether the injectables will eat into your lifetime infertility maximum. I was thrilled that my first round of drugs were covered with like a $50 copay but I later found out it cost me $19K out of my maximum. If I had paid out of pocket, it would have been a $4K cost.
You can ask your insurance company whether drugs count against your max -- sometimes they do, sometimes they are calculated separately. |