One common question that patients have when considering fertility treatment is: “what will my insurance plan cover and how much will my out-of-pocket expense be?” When planning for the financial aspects of moving forward with fertility treatment, there are two sides of the coin to consider—the clinical costs and the medication costs.
Patients are often surprised at the cost of the injectable medications used for fertility treatments such as in vitro fertilization (IVF). For many, insurance will help to significantly reduce the out-of-pocket costs. But when insurance isn’t an option, pharmaceutical companies offer their own financial programs to help patients. Understanding your options and working with your dedicated medical team can help you save.
Tip 1: Understand how the process works.
Informed patients can achieve the greatest cost savings when it comes to medications. Understanding the medications and the discounts and programs offered by their manufacturers can help make navigating the financial options easier.
Commonly-prescribed stimulation medications: Frequently, physicians prescribe follicle-stimulating hormone (FSH) medications to intrauterine insemination (IUI) patients (who are using injectable medications) or IVF patients during the follicular development phase of the cycle. These medications work to recruit, develop, and grow multiple follicles which contain an egg. For most patients, the stimulation medication makes up the bulk of their medication cost.
To watch our On-Demand Webinar on Low-Tech, click here. During this free, on-demand event, viewers will learn more about who is a good candidate for low-tech treatment, how ovulation induction (OI) and intrauterine insemination (IUI) work, and the success rates associated with these treatment options.
Common FSH Brands:
- Gonal-f® manufactured by EMD Serono
- Follistim® manufactured by Merck
Does brand matter? While there are several pharmaceutical companies that manufacture stimulation medications used during fertility treatment, extensive medical research has shown no benefit to choosing one brand over another from a medical standpoint. Studies have proven them to each be effective for ovarian stimulation.
How does my physician determine which brand to prescribe? Shady Grove Fertility prides itself on being able to negotiate discounted medication costs on behalf of their patients, for patients are paying out of pocket for their medications. As such, generally one formulary of medication will be prescribed for patients paying out of pocket, such as Gonal F, providing the largest cost savings to the patient. For those with insurance coverage, SGF will ensure the correct formulary of medication is prescribed, allowing medication benefits to be utilized.
Tip 2: Be your own advocate.
Use your resources: When preparing to start a cycle, find out who will handle your prescriptions on your medical team—it will likely be either the clinical assistant or nurse. This member of your team will order your prescriptions and help you when it comes to making sure you are prescribed the most cost-efficient medications. SGF has identified RARx Pharmacy as their Preferred Pharmacy; providing patients with savings and excellent customer service, in addition to being able to fill for most insurance providers.
Call your insurance company: When planning to use insurance benefits to cover the cost of treatment, proactively speaking with your insurance provider to determine their preferred brands can help ensure your physician prescribes the most cost-effective medication. It is also important to understand your insurance coverage; if you have combined medical and prescription coverage, pulling from one lifetime financial cap, many patients find that using their coverage on their medical treatment, and paying out of pocket for their medications, leads to the best coverage and out of pocket spend.
Know your medical protocol: This step is especially helpful for patients planning to pay out-of-pocket. RARx Pharmacy, a mail-order pharmacy, as well as the preferred pharmacy for SGF, will contact the patient directly to provide a quote for the medication before filling the prescription. In addition, RARx will explore your insurance benefits, and assist you in knowing how best to manage your coverage Vs out of pocket expenses. Knowing the type of medications prescribed and an idea of the cost can help address any potential issues prior to filling the medications, saving both time and money.
Tip 3: Consider a pharmaceutical financial program for medication.
Fertility Finance offers loans on medications, allowing patients to borrow money for fertility treatment, and medications, or medications alone. When combined with discounted medications, for those paying out of pocket, patients are able to maximize their options. To learn more regarding finance, please go to Fertility Finance.
EMD Serono’s Financial Programs
Compassionate Care Program
- Discounts on Cetrotide, Gonal-f, and Ovidrel.
- Program offers a four-tier discount program (10%, 25%, 50%, or 75%) based on income and other factors.
- 25% discount for all military active duty, veterans, and retired—no income verification required.
- Upfront savings—approved participants will receive a discount card to present to the pharmacy.
- Learn more about the Compassionate Care Program
Self-Pay Medication Discount Program
- Self-pay patients can receive a combined discount of 25% off eligible medications from RARx Pharmacy. This discount cannot be combined with other discount options.
- Available to patients who do not have insurance benefits—or for those who waive their benefits due to high deductibles, poor coverage, or a lifetime financial cap.
- Medications eligible for a combined 25% discount: Gonal-f, Cetrotide, Menopur, hCG, Leuprolide Acetate 2 week kit, Endometrin, birth control pills, Zithromax, and Estrace.
- Participating pharmacy= RARx Pharmacy, https://rarxpharmacy.com/
- See if you qualify for added savings.
- This program is unique to Shady Grove Fertility patients.
Finding ways to make medications more affordable doesn’t have to be a daunting task. Working with your dedicated medical team to identify the most affordable options can help to reduce the out-of-pocket expenses associated with fertility treatment.
Editor’s Note: This post was originally published in 2014 and has been updated for accuracy and comprehensiveness as of March 2019.