WOW!!! $4600 doesn't seem like 50% co-pay, especially when it is only $1000 cheaper than paying cash. Looks like Aetna does increase their prices.

When I had MDIPA, my meds for IVF (all injectables- gonal f, menupur, ganirelix, hcg; vaginal inserts; oral) cost about $360. With Aetna (hmo fed open access, 50%IVF co-pay), the same amount of meds cost a little over $4600 which was about $1000 cheaper than paying out-of-pocket. Of course, $4600 is a lot more than $360, but what can you do when you need the meds.

I wasn't able to get authorization for meds from Aetna for about two and a half weeks despite calling them several times. The key is to ask your doc's office to call the authorization department directly and ask that they expedite it if you need your meds immediately. I got authorization for meds ONE day after my doc's office called Aetna. If you need meds immediately, your doc's office can work wonders. . . or at least mine did.

Anonymous wrote:Has anyone been able to get a break down or itemized list of prices for injectable IVF meds from Aetna Specialty Pharmacy? I have federal aetna hmo plan which covers 50% injectable meds for IVF but from what I read about Aetna and how they double their prices, I am wondering if it would be cheaper to pay out of pocket for the meds from Freedom Pharmacy.

I don't have an answer to this question, but both times I did IVF and paid out of pocket through Freedom Pharmacy, it cost about $3500-$4000 total for my medication -- Lupron, Gonal-F, trigger shot, prometrium. From the prices I've seen in the thread above, it does sounds like Aetna may be nearly doubling their prices on you. I am a Fed and opted to stick with BCBS despite the lack of IVF coverage because I couldn't get a straight answer out of Aetna even during the open season period about when I'd be eligible for IVF coverage. I am still paying off the loan I took to do the SG Shared Risk program plus a couple of rounds of meds, but my 2.5 year old was worth it.

17:30 - did Aetna give you a list of prices for each med?

My meds from Aetna were 4K for IVF

Has anyone been able to get a break down or itemized list of prices for injectable IVF meds from Aetna Specialty Pharmacy? I have federal aetna hmo plan which covers 50% injectable meds for IVF but from what I read about Aetna and how they double their prices, I am wondering if it would be cheaper to pay out of pocket for the meds from Freedom Pharmacy.

Ooohh--I could tell you a doozy of a story when it comes to finding out what Aetna charges for ivf meds. I made many phone calls to that da**ed pharmacy and still couldn't find out the prices of the meds. At one point I was directed to aetna pharmacy management (800-238-6279) and spoke with a really nice person who gave me pricing information that was entirely wrong. But, one thing I did learn from our conversation is that ivf injectable meds are covered under the medical benefit which covers 50% of the cost. All other meds (oral meds/vaginal inserts) are covered under the normal pharmacy benefit (not sure what that coverage is, I think $3 copays for generic, formulary meds, $10 for generic nonformulary, etc.). BTW, this is for the federal aetna hmo plan. When I finally did get authorization for the meds and the pharmacy got with it, I received my meds the day before I was to start the injectables--so pp, I understand your stress--it was a horrible waiting game. With pricing--last time we did ivf we didn't have insurance coverage and spent a little over 4k on meds. This cycle w/ the 50%aetna coverage we spent a bit over 2K so it did turn out to be half of what we paid when we didn't have insurance. Lastly, I don't think aetna wants us to know the prices of the meds--when they finally did send them out, I had to ask for the total cost (they took my credit card # over the phone but didn't know what my cost was--they had to call me back so they could find out!!) and if that total is itemized on the receipt --the rep said the don't show individual totals of the meds. At that point I was just so relieved that my meds were finally being sent out that I chose not to pursue it. Keep calling aetna back pp and make sure they know when you need to start taking meds. Ask if they could expedite your authorization. Good luck!

Anonymous wrote:We switched to Aetna during open season because they offer better coverage. Got started on our first round of IVF 10 days ago. Supposed to switch to stimming on the 13th, but Aetna still hasn't authorized the meds. The order was put in on the 3rd. The pharmacy told me yesterday that Aetna has 72 hours to authorize, but that they still haven't heard back even though we're past that window. Now I'm going to have to call and fight with them today or I won't have the meds in time to start. WTF???? Is anyone else having this problem? And if you are with Aetna and expecting things to be working, you might want to call and check.

I am in the same boat. my meds were sent to Aetna Specialty Pharmacy by my doctor's office two weeks ago and I still have not heard from them regarding the meds. I've called the specialty pharmacy 3 times and was told that someone will contact me, but of course, no one has called. I've already called my doctor's office twice to see what can be done to speed up the process. I am sooooo stressed because I need my meds this week and Aetna doesn't seem to care. We had MDIPA last year and it was wonderful, especially with the meds. Does anyone know how much Aetna charges for IVF meds? I'm suppose to have 50% copay for IVF meds but I heard that Aetna doubles their prices anyways so you are actually paying the full price. Does anyone know how much they charge?

I am wondering that too. I posted previously on this thread. I finally got my trigger shot yesterday. They pay 50% per my policy. They paid $73.54, my share is $73.55. SERIOUSLY, after all that they couldn't give me the penny! If I have to go through this again, when it is all said and done, I am fighting them for that penny!

15:26 here. Glad to hear you got things squared away OP. I had bad experiences dealing with aetna when I tried to get information from them about my benefits--it's unbelievable how much misinformation was given, so I'm glad to know they were helpful for you.

I have also wondered if it's worth it for the money you save. The first time we did IVF we had no insurance coverage so that was added stress. I was thrilled, going into this round of IVF, that we have coverage but dealing with aetna hasn't been helpful for my mental health and stress levels. It's amazing how much easier it was to get meds(albeit waay pricier) when you don't have to deal with insurance. From what I've read on this forum it sounds like MDIPA is the better way to go.

Anonymous wrote:You are lucky most insurances don't cover any ivf

And your point is? I hate when people come on here with sour grapes. So OP shouldn't be frazzled because her insurance completely dropped the ball? If you can't be supportive (esp. on a post where the OP is specifically asking how to handle a very real situation), why not just keep your comments to yourself?

Anonymous wrote:You are lucky most insurances don't cover any ivf

All of the federal HMO's cover IVF (Aetna, Kaiser, MDIPA) which is why I got a federal job. Aetna is a total rip off because they double the price of their meds. MDIPA is about 150.00 for all meds vs. 4 - 5K for Aetna!

Whoops, that should be OPM

When this is all said and done and hopefully I have healthy baby, I will switch back to BCBS FEHB and I plan to write a nice, long, detailed letter to the insurance commissioner, aetna and ppm detailing how what should be simple ends up being one of the most stressful parts of TTC ing. It will probably fall on deaf ears but at least it will be a start. If no one ever complains to them then non one knows there is a problem to fix! Good luck to y'all! May this journey be quick for all of us.

15:26 - this is the OP. What you describe is EXACTLY what happened to us. We got it sorted out today after I didn't listen to the pharmacy and called Aetna directly. It took hours of time - while I was at work (where everyone can hear). Really crap experience but I do think we're on track now.

But, wow! Did I EVER have sticker shock. The doctor told us to expect around 3k for meds and it was just shy of 5! If we do this again I'm going to shop around and see if there are better deals. This process is a total PITA. and I'm not even sure it's worth it for the money you save.

Thanks, as always, for the support my fellow TTCers.