Federal Health Plans & IVF coverage

[Anonymous]

With BCBS I paid a little over $200 and got enough meds for three cycles. You have to order through their specility/mail order pharmacy Accredo

[Anonymous]

Anonymous wrote:With BCBS I paid a little over $200 and got enough meds for three cycles. You have to order through their specility/mail order pharmacy Accredo

Wow, great info. Do you have to set this up through BC/BS before you have your nurse put in the order for your drugs? Can you please explain the process a bit?

[Anonymous]

We have MDIPA and Shady Grove ran a fake client under the insurance for IVF drugs and NOTHING was covered. It is Sept 2010 so how are you all only paying only $200 for drugs?!

[Anonymous]

PP at 20:06 -- I think they are saying they have BCBS which does cover drugs but not the IVF procedure. MDIPA does cover drugs up to 50% for IVF. That is what the plan brochure says anyway.

[Anonymous]

Anonymous wrote:I did one round of IVF with BCBS Federal and it cost us 8900 at CFA. The drugs were covered but the monitoring b/w and u/s were not. (2009) If the interpretation is different now and the monitoring is covered, then hopefully the price for an IVF round will also be lower.

Does you know what the drugs end up costing with BCBS Federal (standard option)? I have looked through all the literature and it's very unclear.

Also, does anyone recommend the "shared risk" ($22k!) plan at Shady Grove?

Thanks!

[Anonymous]

BCBS covers drugs under the prescription plan.

MDIPA covers the drugs for an IVF cycle under medical NOT under the prescription plan. My nurse ordered my drugs and I paid around 175 for everything and I was on the max amount of drugs.

[Anonymous]

2011 plans were just released and I don't see any that cover IVF (I'm in Atlanta, not DC so I can't get MDIPA). Did Aetna previously cover IVF? It doesn't look like they do now. I wish I'd had one of these options that pays for IUI when I had that this year! We need IVF though now and are trying to pick the best option--at least one that pays for the meds.

[Anonymous]

Last I checked Aetna's HMO covered IVF.

[Anonymous]

I am on BC/BS Federal Basic and went through 2 IVF cycles last year with all of my medications covered. I just got a letter yesterday that included a big list of basically all fertility medications stating that prior authorization will be needed for all of these medications and that they will no longer be covered if they are used in conjuction with ART. I'm thankful for the drug coverage we had (and we are done with IVF with my own eggs), but it made me concerned for others who will no longer have coverage of these medications.

[Anonymous]

WOW. That is really shitty. Thanks for the info 12:14.

[Anonymous]

Yep. Just checked 2011 brochure - p. 104. No more drug coverage for ART under BCBS.

[Anonymous]

But what about for timed intercourse or IUI?

[Anonymous]

For timed intercourse I would think it is covered b/c the language says:
Not covered:
• Drugs used in conjunction with assisted reproductive technology (ART) procedures

Timed intercourse isn't an ART -- so I'd think it would be covered. IUI -- no.

[Anonymous]

I just got the same letter. Until this past year I had BCBS and it was really nice that they used to pay for this stuff. Sigh.

[Anonymous]

I posted above at 12:14
Yeah, I was really disappointed to see this change. It always makes me bitter how infertility is viewed so much differently from other medical problems.
I agree with the previous poster that these medications would be covered if done in the context of timed intercourse. However, when you reallyneed the coverage is like in IVF when you might have $5K+ in meds. That's why it's such a bummer (although it's still good that you can get them covered if you are doing TI).