This is part two of figuring out finances. Your clinic will be able to give you information regarding costs for your clinic, but they are not a pharmacy and have no idea what your medications will cost. Don't even bother asking them.
At your IVF consult you should ask for a copy of what medications you will be on. Even if they don't give you the actual prescriptions at this point, you should see if they can give you an idea of the medications and dose they expect you to be on.
A major factor in choosing an insurance plan is what they offer for medication benefits. As I mentioned in a previous post, BCBS, Aetna, and UHC all offered an additional $5,000 for medications on top of the $15,000 for medical. Cigna did not offer the additional $5,000. Also, as you will recall, I warned you that $5,000 is not as much as it seems.
Try to follow along but medication benefits can get confusing...
Medications are the opposite of treatment when it comes to getting the best bang for your buck. Insurances will charge a much higher fee for medication than if you pay for it out of pocket. In contrast, for the actual IVF treatment, it's much "cheaper" to go through insurance.
For example...
I was prescribed two pens of Gonal-f 900iu. When I called Cigna to check the price through their pharmacy they told me one pen was $2,500. At the mail-order pharmacy my clinic recommended, one pen was $990. Less than half the cost! The catch is that if I get the one that's $2,500 it goes towards my $15,000 fertility maximum. So do I use that precious money on one medication or just pay $990 cash?
This same theory is applied to all of the insurances. Because the insurances charge so much more for medications, you can usually only get a few of them for $5,000 and then will have to pay out of pocket for the others, or, in some cases, apply it towards your $15,000 medical benefits.
Here's the process I used to figure out where to purchase my medications.
First, call the insurance company. Some insurance companies require you to fill these special fertility meds as a specific pharmacy. So if you want to use your $5,000 benefit (if applicable) you cannot shop around. This is good to know! Most of these pharmacies will be able to give you a price estimate before you are active with their insurance.
I created an excel sheet to keep track of prices for meds at different pharmacies and for each insurance.
Second, call a specialty pharmacy. My clinic preferred Encompass Specialty Pharmacy. This is where they normally send their patient's prescriptions as they found they offer the best pricing. Now, I'm not sure if they have a deal worked out between them to give patients from my clinic better pricing, or if that's their everyday pricing. Some other specialty pharmacies people get meds from are Freedom Fertility and SMP Fertility Pharmacy. There's tons of others so see what your clinic recommends. Call them all if you want to try and get the best cash price!
Third, look international. This is not for everyone, but you can get amazing deals on medications if you're willing to look out of the country. Remember the medication that was $2,500 through insurance and $1000 from the recommended specialty pharmacy? It was $460 from a pharmacy in London. WHAT?! My husband (and admittedly me) was wary of ordering meds from overseas. They are not FDA approved (obviously) and their efficacy cannot be verified. However, most of them are made by the same manufacturer as what you would get in the US, they just have European packaging. Europe has more regulation on med prices (whereas in the US you can charge as much as you want) so that's why it's so much cheaper for the exact same thing.
The two international pharmacies I've heard of most people using are IVF Meds and Fast IVF. You still need a legit prescription from your doctor that needs to be faxed or emailed to them before they will send you anything. I'm sure there are many other options, but I just know people have had good experiences with these two and they both have a lot of other accreditation. You definitely don't want to just go to some random pharmacy!
I ended up using a combination of all three of these options!
I used IVF Meds for two of the most expensive medications (Gonal-f and Cetrotide). I had to make an account online, send them a copy of my prescription, and pay for the meds. Paying was a little sketchy because they wanted a wire transfer and does any legit place use wire transfer in this day and age?? I had heard others used Mastercard but when I asked about that they said their card machines were down so wire was the only way. Hey, when a girl wants to save some money, she will do just about anything!
I didn't realize I could wire from my bank's phone app so I went in to the bank to do it. The girl helping me probably thought I was crazy because when she asked what country it was going to...I didn't know. I had to find the email with all the information and I was like "looks like London...." Then she asked what the money was for and I wasn't sure if I was allowed to say medications so I was like "uhhhhhh" and then she gave me a bunch of options so I chose "goods" hahahaha Oh man I was just praying it all turned out fine!
The specialty pharmacy my clinic sent me to actually beat the international pharmacy on some of the meds, and some they were essentially the same so I got those there too. Encompass also sent me alcohol swabs and a sharps disposal container to use.
Lastly, for some of the meds needed for the FET, I went through Cigna pharmacy. They were only a few hundred dollars, as opposed to thousands, so it was definitely worth it to dip into the $15,000.
I have heard that you can pay cash for meds and then bill the insurance after the fact and hope they reimburse you for the cash price. I have not tried this yet. I also don't know if it makes a difference if it comes from a US pharmacy or overseas. I'm definitely going to try this and will post an update with what I find out in the future!
Update: I spent a LONG time on the phone with multiple people from Cigna finding the answer to this question. Long story short, if they are in network with the pharmacy, then you can submit a bill back to them for reimbursement. If they are not in-network you can still do that but it will go towards your $15,000 AND your OON OOP max (which would be really stupid so don't do that!).
Calculate your monthly income, pick a budgeting method and monitor your progress. The next step is to keep track of your income and expenses. Knowing where every pound is holding spent is a vast first step to starting your savings getting out of debt, or preparing for retirement.
ReplyDelete