April 2016 - IVF #3, Prescriptions & Insurance

On Tuesday, despite the uncooperative follicles, the office decided to go ahead and call in my round #3 medications to the pharmacy.  Well, pharmacies, actually, as this time there will be two separate sources.  Conception Pharmacy will provide the Ovidrel, Menopur and Follistim, while Freedom Pharmacy will provide the Lupron, which it seems Conception does not carry.

Wednesday I got a call from the senior nurse, Rachel.  Conception Pharmacy checked, and my insurance doesn't cover the Follistim, but it does cover the Gonal-F.  She had spoken with my doctor, and while he had wanted to try the Follistim to try something different, he was ok for me to use the Gonal-F instead, since, if you recall "they are like Dr. Pepper vs. Coke" of follicle stimulating hormones (FSH).

I called Conception Pharmacy. How bad could the cost difference be?  Was it worth it?

Candace answered, and Candace told me this:

me:  "Hi Candace!  My name is Kelly Canning.  I hear you all have a prescription for me, but that part of it is not covered by my insurance."

Candace:  "Hi Kelly.  Yes, it looks like the Follistim isn't covered, but the Gonal-F is.  They are essentially the same, just a difference in brand.  When I saw this yesterday, before I called your nurse, I checked with the head pharmacist...it's the same exact formula."

me:  "Ok.  Good to know.  Just out of curiosity, how much of a cost difference is it for me to pay out of pocket for the Follistim?"

Candace: click, click click. "Hmmm...ok, so the Gonal-F is nearly fully covered, only a $150 copay.  We also have a discount coupon with the manufacturer, so it will actually cost you nothing."

me:  "Nothing?  Wow!"

Candace:  "Yep.  Let's see, for the Follistim..." type, type, click, click. "That would be $3,600 out of pocket."

me:  "Holy crap."

Candace:  "Yep."

me:  "I know this sounds like an obvious decision, but let me call you back."

I texted Michael the issue, and then called Rachel back.  I needed to hear from her directly, not just over voicemail, that the desire to try something different and it's potential positive effect wasn't worth the $3,600.  She said it was absolutely not worth that amount to try it.

I called Candace back and ordered the Gonal-F, Menopur, and Ovidrel today.  Freedom Pharmacy will ship the Lupron.  The protocol is still new / different, and the Lupron is thankfully going to work out.

Moral of the story.  Insurance is great to have and it's rare to receive infertility coverage at all.  What it does and doesn't cover can be unpredictable.  Sometimes you've gotta roll with the changes and hope for the best.  If we have to go to rounds #4, #5, etc...we might need that $3,600!

Round #3 meds are now ordered and should arrive via FedEx this Saturday and next Saturday!