Medco coverage review


#1

I am trying to gather medication cost information before our first IVF appointment on the 9th. I registered at medco.com to see if I could get some online pricing, but it won’t give me anything and says I need a “coverage review”.

Anyone done a Medco coverage review? Is it easy to “pass”? I know some insurance companies will deny coverage if things aren’t filled out correctly. Also, does Medco offer good prices?

I do intend to call them next week with my questions, but wondered if any of you had already dealt with them and what your opinions/advice might be.

Thanks!
AJ


#2

I have medco coverage. My fertility clinic orders the meds for us they say they can get the best prices. They ordered my meds through walgreens specialty pharmacy. They were so amazing they called me and got my insurance information then they dealt with the insurance company.i did have coverage but on the super expensive meds (bravelle and menopur) it was cheaper to pay cash because you get a cash discount plus my doctor sent coupons with my orde. I don’t know your protocol but my meds cost 2200$. We were expecting to pay 3500 so we were super excited. C did your re say you needed to find out about your meds??


#3

Hi nllain,

I haven’t found out my protocol yet. I am trying to get as many answers before I go, because it might help us decide whether we do their cost sharing program (and no insurance) or straight IVF using our insurance ($10,000 lifetime max).

The lifetime max is through BC/BS, so I know I can get my meds through that if Medco doesn’t cooperate, but I’d rather save that money for the actual procedure.

So much to think about!!

Thanks for the info!
AJ


#4

AJ, I have BCBS and it covers my meds. I have a $45 copayment each on follistim and menopur and we specifically do NOT have IF insurance throughout them. This is my husbands insurance

My primary ins is Cigna and I di have $10,000 life rime max IF coverage with them. My meds are cheaper so BCBS but before I knew that my plan administrator told me that the meds were not considered part of the $10,000 lifetime max.

For what it’s worth. I know that all plans are different but I would call your plan administrator and find out if your meds are even part of the 10k lifetime max

I get my meds from walgreens (schraffs). They were cheaper on BCBS than freedom pharmacy was.

Finding out our meds were covered really changed thecwhole way we approached this process. Hope you have it too!


#5

I think it depends on your individual plan with medco. I used their mail order pharmacy to save even more $$, and got $4800.00 worth of meds for a $175.00 copay. I think their pharmacy is Accredo, but they will transfer you when you call medco. It took them about 2 weeks to get my order straight, but the savings were worth it, and I ordered the meds way early to make sure I had everything on time.


#6

Buttercup5: My meds through BC/BS are considered part of my $10,000 lifetime max, so that’s why I was hoping Medco might be a great deal! I’ve read conflicting information about them though.

casak: Wow, you got quite a discount! I’m really hoping :cross: that I have the same sort of plan as you do! It would be really helpful to not worry about the cost of the meds so much.

Thanks ladies!


#7

In case anyone comes back to read this:

I called Medco today, and the coverage review is based upon what your employer benefits coordinator set up for your prescription drug plan. So, if the doctor tells Medco you want Follistim for IVF, but you only have IUI coverage, they will deny coverage.

It sounds like I may only have to pay a deductible to get my meds, which is amazing!!

AJ