Last entry we discussed the intricacies of investigating your medical benefits for fertility treatment coverage. In today’s post we will dive into some of the more important things to consider when looking into whether the fertility drugs your doctor has prescribed are going to be covered under insurance.

To being with, it is important to remember that prescription drug coverage, like your medical coverage, often “resets” on the first of the year. Meaning that the coverage that you had in 2013 may differ from the coverage you now have available depending on if your employer made any plan changes. Similar to our process of investigating medical coverage, the first step is going to be to determine from your physician what your course of treatment is going to be. Even once your particular treatment cycle has been determined (e.g. IVF, IUI, etc.), your medication protocol will often be customized to your case by your physician. In determining your prescription coverage you should ask your nurse or physician if they can provide a list of medications with which they are planning to treat you. Even though this is something that may not be set in stone until shortly before you start your treatment, a list of possible medications should allow you to establish whether the therapy will be covered in any way. Once you have the list of potential drugs you can again reach out via phone to your prescription insurance company to see if any of the medications will be covered. In addition to seeing what kind of medication coverage you have available you should also plan to ask the following:

  • Do I have any kind of deductible for prescriptions that needs to be met?
  • What are the estimated copays I will have for my fertility medications?
  • Is there a maximum amount covered for fertility drugs through my prescription benefit?
  • Is there any pre-certifications or prior authorizations my physician needs to complete prior to my insurance covering medications?
  • Is there a preferred or required pharmacy at which I need to get my fertility medications filled?

Arming yourself with this information ahead of time will greatly help in being prepared for the out of pocket cost you will have for your cycle of medications. In addition to the option of contacting your insurance directly, we at Freedom Fertility Pharmacy offer an insurance inquiry where a member of the Freedom team will complete the pharmacy benefit investigation on your behalf and often times have results back to you within 72 business hours. It’s important to note that with both medical and pharmacy insurance, exact coverage cannot be guaranteed until the actual claims are billed and adjudicated through your plan.

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