Question for those who bought insurance on the MD exchange for IVF

[Anonymous]

Anonymous wrote:For the MD Carefirst plans, did anyone get coverage for Menopur or Cetrotide during 2019? I don't see those listed on their formulary, and I'm worried they aren't covered.

Also, FWIW in terms of banking, the financial counselor at Shady Grove said that Carefirst treats a transfer as a "cycle" and will cover additional egg retrievals before you complete your third transfer. So, according to them, you can use it to cover egg banking retrievals (and SGF often suggests this to patients).

They were covered this year. I remember seeing last year on the website that Menopur wasn't covered, but it was. I think I only paid $200 copay for 25 vials.

[Anonymous]

Anonymous wrote:

Anonymous wrote:For the MD Carefirst plans, did anyone get coverage for Menopur or Cetrotide during 2019? I don't see those listed on their formulary, and I'm worried they aren't covered.

Also, FWIW in terms of banking, the financial counselor at Shady Grove said that Carefirst treats a transfer as a "cycle" and will cover additional egg retrievals before you complete your third transfer. So, according to them, you can use it to cover egg banking retrievals (and SGF often suggests this to patients).

They were covered this year. I remember seeing last year on the website that Menopur wasn't covered, but it was. I think I only paid $200 copay for 25 vials.

And centrotide was covered as well

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:For the MD Carefirst plans, did anyone get coverage for Menopur or Cetrotide during 2019? I don't see those listed on their formulary, and I'm worried they aren't covered.

Also, FWIW in terms of banking, the financial counselor at Shady Grove said that Carefirst treats a transfer as a "cycle" and will cover additional egg retrievals before you complete your third transfer. So, according to them, you can use it to cover egg banking retrievals (and SGF often suggests this to patients).

They were covered this year. I remember seeing last year on the website that Menopur wasn't covered, but it was. I think I only paid $200 copay for 25 vials.

And centrotide was covered as well

Thanks so much! That is comforting.

For those who are interested or in a similar position, after doing a ton of research I ended up going with the CareFirst BlueChoice HMO Gold plan through the MD exchange.

[Anonymous]

Hi there OP and others. I have a follow-up question to OP original question. I see there is a CFBC Gold (1750) and Value Gold options on the exchange. I am trying to determine which is better for the IVF coverage. The Gold version seems to have a separate $150 deductible for meds, which a PP mentioned is better than having a combined deductible. From what I have read on this site, it looks like going to Shady Grove will mostly be co-pays and if so are there any other benefits from one over the other? Thanks for any clarification.... this has always been the confusing part for me.

[Anonymous]

Anonymous wrote:For the MD Carefirst plans, did anyone get coverage for Menopur or Cetrotide during 2019? I don't see those listed on their formulary, and I'm worried they aren't covered.

Also, FWIW in terms of banking, the financial counselor at Shady Grove said that Carefirst treats a transfer as a "cycle" and will cover additional egg retrievals before you complete your third transfer. So, according to them, you can use it to cover egg banking retrievals (and SGF often suggests this to patients).

Yes I did two back to back cycles and they were covered.

And I had no trouble at all getting my meds including Menopur and Cetrotide. You just have to order through CVS Caremark.

[Anonymous]

Anonymous wrote:

Anonymous wrote:For the MD Carefirst plans, did anyone get coverage for Menopur or Cetrotide during 2019? I don't see those listed on their formulary, and I'm worried they aren't covered.

Also, FWIW in terms of banking, the financial counselor at Shady Grove said that Carefirst treats a transfer as a "cycle" and will cover additional egg retrievals before you complete your third transfer. So, according to them, you can use it to cover egg banking retrievals (and SGF often suggests this to patients).

Yes I did two back to back cycles and they were covered.

And I had no trouble at all getting my meds including Menopur and Cetrotide. You just have to order through CVS Caremark.

Also, Ambulatory Pharmacy in Rockville somehow works with Caremark. My nurse ordered through them since CVS was out of stock for one of my meds. I highly recommend them, they were very easy to work with since it's a small business.