The IVF meds game, part II

This morning, after the rush time at my job was over, I phoned David's medical insurance company to ask why they'd told the pharmacy that I had to call yet another pharmacy to get my Follistim and Repronex.

Just to recap, I have insurance that won't cover the meds. David's insurance covered the meds for the first IVF (with a huge co-pay, but everything helps...)

So when I phoned this morning to find out what was going on, David's insurance company said they hadn't told anyone that I needed to contact a specialty pharmacy  In fact, they said they will cover those meds regardless of what pharmacy we use. (Not entirely, but 55 percent, which is great.)

I don't know where the disconnect happened between this pharmacy, I'll call them pharmacy F, and David's insurance company.  But the news is good, so it doesn't really matter.

I asked the very nice girl on the phone this: If I pay cash for the drugs (to get the lower cash price) and then submit a claim, will you still cover the drugs? 

She said yes, the company would still cover the drugs.  So I made sure I got her name.

Then I decided to call around and see if there were big price differences. I did this off-handedly. I really didn't think there would be much of a difference. Boy, was I wrong!

I only spoke with two pharmacies in the United States.  But check out the price difference for Follistim. At one pharmacy the price was $975 for the Follistim AQ Cartridge at 900 IUs.  And at the other pharmacy the exact same thing was $599.  Now I need three of these cartridges and one of the 300 IU ones, so we are talking about a price difference of more than $1,000 by going with one pharmacy instead of another.

The difference for Repronex was less dramatic -- $5 per vial.  But since I need 10 vials, it adds up to $50.

I'm glad I made the call. 

I still don't have this filled yet, but am hoping to get that finished by the end of this afternoon.

On a side-note, the folks at pharmacy F  (the one that we won't be using) told me that my state, California, is one of the worst in terms of getting insurance to pay for drugs. This pharmacy actually has customer service specialists to deal with California customers. 

They also said that there are 10 states where employers are required to cover infertility in their health insurance plans. She didn't know all their names. I think one is Massachusetts though, and another is New Jersey.

Here's a list of employers who offer some form of infertility coverage. Keep in mind, however, that insurance coverage is always changing, so make sure you double check any information before relying on it.  That saves a lot of unpleasant surprises as you go along in an already very stressful time.

Pharmacy F found it surprising that I would want to know the total cost of the drug (in addition to knowing what the co-pay would be.)

But here's my logic around that: Since David's insurance gives us a $10K lifetime max for infertility and my insurance gives us a $10K lifetime max for infertility, I want to make sure we get the most out of that money as we can.  If we run through our allowance because we paid more for drugs than we needed to, then we will end up paying on the other side anyway when we've run through our $20K total.

We are lucky that we have any insurance that pays for any of our infertility treatments at all.  There are plenty of people who have to come up with all the money out of pocket.