BCBS infertility coverage for feds

[Anonymous]

Anonymous wrote:

Anonymous wrote:Update on meds cost - my total copay for all my meds was $260 ($65 copay for four different meds) vs paying about $6k for these drugs out of pocket for one cycle. Yes, this plan is a no brainer on meds alone.

Are the medicine expenses counted towards the $25,000 total infertility coverage? CVS specialy charges four times of the regular price at other pharmacies. Shouldn't we buy the drugs out of network and only use $25,000 toward IVF procedures, if expecting mutiple rounds of IVF?

Read the policy - no they aren't. You get coverage for three rounds of meds per year in addition to $25k for ARTS per year. These are two separate pots - the $25k is towards the ARTs procedures covered alone. If you think $260 in copays for 48 vials of menopur, 4 900 unit pens of follistim, 7 cetrotide pens and a trigger shot is a lot I don't know what to say about your realistic expectations of infertility med costs. The CVS specialty is a $65 copay per med for a 90 day supply so your RE would order the max of what they think you need.

Re-read the site:

Members diagnosed with infertility can receive up to three (3) annual drug cycles for in vitro fertilization (IVF). You must receive prior approval and buy your prescriptions through our pharmacy programs.

Standard Option members diagnosed with infertility can get any assisted reproductive technology (ART) procedure (not listed as an exclusion in the brochure). We will cover up to $25,000 annually once you receive prior approval.

https://www.fepblue.org/open-season/whats-new-2024

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Update on meds cost - my total copay for all my meds was $260 ($65 copay for four different meds) vs paying about $6k for these drugs out of pocket for one cycle. Yes, this plan is a no brainer on meds alone.

Are the medicine expenses counted towards the $25,000 total infertility coverage? CVS specialy charges four times of the regular price at other pharmacies. Shouldn't we buy the drugs out of network and only use $25,000 toward IVF procedures, if expecting mutiple rounds of IVF?

Read the policy - no they aren't. You get coverage for three rounds of meds per year in addition to $25k for ARTS per year. These are two separate pots - the $25k is towards the ARTs procedures covered alone. If you think $260 in copays for 48 vials of menopur, 4 900 unit pens of follistim, 7 cetrotide pens and a trigger shot is a lot I don't know what to say about your realistic expectations of infertility med costs. The CVS specialty is a $65 copay per med for a 90 day supply so your RE would order the max of what they think you need.

Re-read the site:

Members diagnosed with infertility can receive up to three (3) annual drug cycles for in vitro fertilization (IVF). You must receive prior approval and buy your prescriptions through our pharmacy programs.

Standard Option members diagnosed with infertility can get any assisted reproductive technology (ART) procedure (not listed as an exclusion in the brochure). We will cover up to $25,000 annually once you receive prior approval.

https://www.fepblue.org/open-season/whats-new-2024

sounds very good. did you or anybody call the customer services to confirm that infertility drugs are not counted towards the $25,000 annual costs? Thanks

[Anonymous]

I literally just had them processed. You can call them yourself.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Update on meds cost - my total copay for all my meds was $260 ($65 copay for four different meds) vs paying about $6k for these drugs out of pocket for one cycle. Yes, this plan is a no brainer on meds alone.

Are the medicine expenses counted towards the $25,000 total infertility coverage? CVS specialy charges four times of the regular price at other pharmacies. Shouldn't we buy the drugs out of network and only use $25,000 toward IVF procedures, if expecting mutiple rounds of IVF?

Read the policy - no they aren't. You get coverage for three rounds of meds per year in addition to $25k for ARTS per year. These are two separate pots - the $25k is towards the ARTs procedures covered alone. If you think $260 in copays for 48 vials of menopur, 4 900 unit pens of follistim, 7 cetrotide pens and a trigger shot is a lot I don't know what to say about your realistic expectations of infertility med costs. The CVS specialty is a $65 copay per med for a 90 day supply so your RE would order the max of what they think you need.

Re-read the site:

Members diagnosed with infertility can receive up to three (3) annual drug cycles for in vitro fertilization (IVF). You must receive prior approval and buy your prescriptions through our pharmacy programs.

Standard Option members diagnosed with infertility can get any assisted reproductive technology (ART) procedure (not listed as an exclusion in the brochure). We will cover up to $25,000 annually once you receive prior approval.

https://www.fepblue.org/open-season/whats-new-2024

How many egg retrieval or embryo implantation procedures does the $25,000 cover if the infertility drugs are not included? They said that it is annual max limit not lifetime limit.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Update on meds cost - my total copay for all my meds was $260 ($65 copay for four different meds) vs paying about $6k for these drugs out of pocket for one cycle. Yes, this plan is a no brainer on meds alone.

Are the medicine expenses counted towards the $25,000 total infertility coverage? CVS specialy charges four times of the regular price at other pharmacies. Shouldn't we buy the drugs out of network and only use $25,000 toward IVF procedures, if expecting mutiple rounds of IVF?

Read the policy - no they aren't. You get coverage for three rounds of meds per year in addition to $25k for ARTS per year. These are two separate pots - the $25k is towards the ARTs procedures covered alone. If you think $260 in copays for 48 vials of menopur, 4 900 unit pens of follistim, 7 cetrotide pens and a trigger shot is a lot I don't know what to say about your realistic expectations of infertility med costs. The CVS specialty is a $65 copay per med for a 90 day supply so your RE would order the max of what they think you need.

Re-read the site:

Members diagnosed with infertility can receive up to three (3) annual drug cycles for in vitro fertilization (IVF). You must receive prior approval and buy your prescriptions through our pharmacy programs.

Standard Option members diagnosed with infertility can get any assisted reproductive technology (ART) procedure (not listed as an exclusion in the brochure). We will cover up to $25,000 annually once you receive prior approval.

https://www.fepblue.org/open-season/whats-new-2024

How many egg retrieval or embryo implantation procedures does the $25,000 cover if the infertility drugs are not included? They said that it is annual max limit not lifetime limit.

Obviously that will depend on the clinic's agreement with BCBS. As we haven't completed it yet, I do not have direct numbers on how this played out in the policy. No one said lifetime policy??? Given that Dominion's private pay is $12,750 for the ARTS procedures - I am going to assume at least two, maybe three cycles as reflective of the three annual drug cycles. Keep in mind that we had to pay $830 of the $12,750 package and are not doing PGT testing which BCBS would not cover so that will bring their private pay price down to $10,920 assuming they charge $1k for PGT testing on four embryos.