Help!!!


#1

First of all, I know that I’m so blessed because I have insurance and so many do not. However, since I’m a low responder my meds will go over my lifetime limit with this cycle (it’s my second). My RE has prescribed me to take 6 vials of Menopur a day for 10 days. The total cost from Walgreens is $5,560 + a $200 copay. Medco (my insurance mail order pharmacy) told me that since I’m going over, they will cancel the order and will not fill it through Medco mail order :grr: so even though it’s SLIGHTLY cheaper, I can’t get it filled there. I can still get it filled from Walgreens as long as I pay the extra amount. I looked up IVF Meds and saw that I could get the Menopur for under $2400. My insurance said they would pay out of network pricing but I could be reimbursed for part. BUT they couldn’t tell me what the approved amount would be. SERIOUSLY??? How can I make a decision to pay out of pocket if I cannot get information about the cost?

Anyone go through this who can help???

This doesn’t include my other meds (ganorelix and hcg injection) but they are, at least, much less expensive. It’s sad when $600-$700 is considered “cheap”.


#2

I may not be reading your post right…your insurance couldn’t tell you what your out of network co-pay would be (or reimbursement)? Maybe have the pharmacy just run the script through their system and tell you what your cost would be. My local pharmacy did this for me. They didn’t actually fill the scripts until I okayed the amount. Another thought, call your insurance back just so you can speak with a different rep (who may have the answers your looking for). There’s been many times I’ve had to do this because the first rep, for whatever reason, could not answer my question.


#3

I am not sure that I am answering your question but can you use freedom fertility pharmacy? on their price list it says menopur is 70.90 per 75 IU vial. I have medco too and I used freedom and they told me the out of pocket cost ahead of time. Great customer service. They ship overnight so maybe you can split the order up. Can your doctor change your protocol? HTH


#4

Yes I used freedom and the menopur was $70 plus they are really nice and very fast. Also mandells pharmacy have a program with the menopur with people that don’t have ins or are over the limit on their meds.
Good luck