With her permission, here is an exerpt from a fellow OOP IVF'ers Blog:
"Even though we aren’t cycling until next month, Dr. K wanted to go ahead and order the meds. I knew there would be several, but honestly, I had no idea exactly how many. Estimated cost? $5,000. That’s just the meds.
Most fertility drugs aren’t available at just any pharmacy. You can’t just walk into CVS and pick up a syringe of follistim. It has to be ordered and generally it’s all ordered from online pharmacies. Dr. K prefers The Apothecary Shop. Last week I got the call that my med order was in and ready to be reviewed and ordered. I asked what he had ordered (since we didn’t really ever go over that with Dr. K since we weren’t sure when we’d be cycling). She starts listing off meds. I lost count. She asked me if we had insurance and when I told her yes and then she told me she doesn’t deal with our insurance at all. So I told her I would call her back.
We have Kaiser (KP) health insurance. Actually, we have a Point-of-Serivce (POS) plan that allows us to see KP and non-KP doctors. It even allows us to bring in prescriptions from non-KP doctors. It doesn’t, however, pay for IVF. As far as I knew, it didn’t pay for fertility drugs either. However, I had to believe they would pay for the antibiotic and a few other meds. I mean, they weren’t specific to fertility. So, I figured I’d try. I called KP on Friday and after 3 different pharmacy locations, I got one that could actually help. KP Garden Grove has a fertility clinic (they do IUIs only) and so they stock many of the meds, plus they are a compounding pharmacy. What I found out is that they would cover some of the meds at copay only and if they stock the fertility drug, it’s a 50% copay. Victory!!!
On Monday I took all 10 prescriptions over to KP Garden Grove. I got an awesome tech who was more than happy to run price quotes for me. All of the “non-fertility” meds were covered at copay only. The total for 5 prescriptions was $120.00. That’s a pretty big savings over having just ordered them and paid full price at Apothecary (I’m guessing about a $500 savings). They also cover Menopur at 50%. Apothecary quoted me almost $2,800 for just the Menopur (KP is $1100). The remaining stimulating and trigger shots aren’t covered and are actually cheaper with Apothecary so I’ll order from there.
The breakdown is about $2900 total combining KP and Apothecary. Had I just gone with Apothecary it would have been about $5000. Everything with KP would be $3,300. It pays to price shop!
And for those inquiring minds …. here’s the list of meds:
I
njections
Follistim AQ Cartridge solution 300 iui (x 4)
Menopur Intramuscular Injection 75 iui (x 40) (this is a lot by the way)
Ganirelix Acetate 250 mcg/0.5mL (x 5)
Pregnyl powder 10,000 units Intramuscularly (this is the trigger shot)
Progesterone in Oil 50 mg/mL Intramuscular (this is done after retrieval)
Other meds
Prometrium Capsules 200mg (x 60 capsules)
Medrol 8mg (x Doxycycline 100mg (x 40)
Vivelle-Dot film (estrogen patches x 10)
Needles/Syringes
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My point is, please price shop! Even if your insurance company doesn't pay for Fertility meds, call them! You might be surprised!! Many of them will pay for the antibiotic, PIO, prometrium, patches, medrol, etc. That can save you a few hundred alone. And as well all know, when you're dealing with IVF, every single penny counts. I saved close to $2,000! I realize many wouldn't get that big of a break, but you don't know if you don't ask. I almost ordered everything from Apothecary without questioning it, and then I realized that I pay high premiums for insurance just like everyone else and I should give it a shot and it paid off.
If I have meds at the end of my cycle and am successfully pregnant, I'm more than happy to donate the meds. I'd rather have someone use them then have them go to waste."
~ KaliChick
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