Giant Box of Needles

So my last post ended on a positive note. Our insurance had agreed to cover most of my medications and the total we paid was around $1200. We were happy with that and relieved to know that everything was set with my medication. Unfortunately we got a call at 7pm on Thursday from CVS and I've been too angry to even begin to write about it until now. Some new information had been sent through from our insurance and somehow we still owe over $6000 for all of my meds....what?!?! Needless to say I am not proud of the way I spoke to the woman on the other end of the phone. I still don't fully understand how we went from $1200 to $6000. They said the prices for insurance are different than out of pocket and I have $3500 max for all fertility meds. They must have forgotten to mention that. Anyway, we went back to mostly our original plan. I asked CVS exactly what meds I could get without going over the $3500 max, I was able to fill all 20 vials of Menopur and 2 vials of the Cetrotide. They threw in a sharps container and some alcohol swabs too. The rest of the meds we got elsewhere for a MUCH cheaper price.

We received the first giant box of needles from CVS yesterday.  I was surprised to see that the Cetrotide came in a cooler with ice packs. Apparently it needs to be refrigerated! We are still expecting 3 more boxes which should be here tomorrow. Brian convinced me to do an "unboxing" video because he says nerdy people like them. I probably should have gone through the box first though so I wasn't just guessing as I went along. I was totally wrong on the different needles! You can pretty much just ignore everything I say, its all incorrect anyway.

New Goodies 

Batman and Renly were more impressed by the box

On a non-med related note, we were expecting RGI to be done with our DNA probe last week. When I spoke with them last Tuesday they said it was on track to be done by the end of that week. On Friday our nurse, Ashley called and said that RGI had contacted her and it would be done the following week. I spoke with our genetic counselor, Divya, today and surprise...it's still not done! While the probe "might" be done next week, we did get the go ahead to start the next step with The Fertility Center. Divya will contact our nurse, Ashley, to give her the green light and hopefully we can get this thing moving. We are just hoping there are no more setbacks.

-Emily

Medication Update

In my last post I mentioned that our doctor had sent through an appeal to get my medications covered by insurance. 2 of the meds, Progesterone and Cetrotide, were initially approved, and 4 of them, Menopur, Gonal-f, hCG and Leuprolide Acetate, were denied. I called the specialty pharmacy department nearly every day to check on the status over the past few weeks. Every day I would get the same answer, “the appeal is still pending”. That is until Monday, when instead I got the answer I was looking for, “Approved!”

Menopur - Approved with just a $70 copay! Just this being covered will save us over $1500!

Gonal – f (Follistim) – Approved. The denied the Gonal-f, however they approved a similar drug called Follistim, saving us nearly $730. This medication seems like it will be more convenient for me. Follistim is injected using a pen like needle. I’ll just put the vial in the pen, twist the dial on the bottom for the correct dose, and use the teeny-tiny needle to inject the medication into the skin of my stomach. Seriously, this needle is tiiiiny! The dial on the pen will also be much simpler than drawing up into a syringe. We are planning a camping trip to Interlochen at the beginning of August, so if my timing is right, I’ll need to give myself injections in a tent. Not Ideal, but the Follistim pen will make this much easier.

Look how tiny that is!! 

Leuprolide Acetate – Denied again. We will need to pay full price for this one out of pocket.

hCG - Denied again. I will take the name brand, Pregnyl, instead which is half the price of the generic hCG. 

So they didn’t approve all of the medication, but 4 out of 6 is pretty good! We are celebrating this as a win. I ordered all the medication yesterday and I am expecting a giant box of needles and drugs to be delivered to my door on Friday. 

I have stressed out about every aspect of the IVF process and almost everything has worked out in our favor. This reaffirms our belief that we are doing the right thing, I received an email that RGI should be done with our DNA probe by the end of this week, my meds will be here on Friday and next week we will officially begin our IVF cycle. 

-Emily

Medication and Naughty Puppies

My last post focused on insurance coverage. They have approved most of the procedures I will need, but medication is another story. It is strange to think that they will pay for the procedures, but not the medications I will need in order to have the procedures completed. Our insurance company approved 2 of the 6 main medications I will need to take. We have prescription coverage through CVS Caremark, so of course we have to fill any covered prescriptions at CVS.

Cetrotide- Approved! Only a $70 copay on this medication. This would have cost us $1600 if we purchased it out of pocket at CVS.

Menopur - Denied - They denied this medication as I am under 37 years old and I have not gone through 3 failed rounds of Clomid (another drug that stimulates ovaries). I need 20 vials of Menopur, which would cost us $3,020 if we filled it at CVS. If insurance does not approve this after the appeal, I plan to fill the prescription through Alexanders Pharmacy in Portage. It is muuuuch cheaper there and we can get it for $1,538 total.

Gonal-f - Denied - This medication denied as our insurance requires the use of a similar drug called Follistim instead (they have some kind of agreement with the manufacturer). The Follistim however was also denied under the same reason as the Menopur. We can get Gonal-f from a pharmacy called Freedom Fertility for $954.50. We do however have a 20% discount card for any Sorono brand drugs so it will be $725.88.

Leuprolide Acetate- Denied - Our insurance will only cover this if it is needed to prevent premature luteinizing hormone surges. My grandfather actually to Lupron for this exact reason while he was fighting prostate cancer. CVS charges $445 for each vial and I need 2. Walgreens price is $325 so we can get all we need for $650 total.

hCG - Denied - CVS will only cover hCG if there has not been an inadequate response or adverse reaction to a similar drug called Ovidrel. The Fertility Center has a policy against prescribing Ovidrel. When I called Walgreens they told me that the generic hCG medication was actually over 2x the price of the name brands Novarel and Pregnyl. She didn't have an exact reason as to why, but she mentioned that most insurance companies will cover the generic version so they charge more for it...definitely not kosher. CVS charges $262 for the generic version and they didn't give me the price for the name brands. Alexanders charges $75 for the name brand and I will only need one vial.

Progesterone in oil- Approved With an $8 copay. This is on the cheaper side of the medication list, but every little bit helps!

I called pharmacies all over this side of the U.S. and even looked into pharmacies in Israel and England. The ones out of the country were a lot cheaper, but there is no way to tell how they are regulated. It would be hard to know how reliable the prescriptions would be. I had some prescription discount cards and coupons too so I had to take that into account. I made myself a nifty little chart so I could keep all of the different prices straight.

Isn't this a great looking chart!! :D

Renly apparently didn't like how the first one turned out. It actually made me laugh after a long day. I just wish I hadn't thrown my scrap paper with all the pharmacies and prices away...lesson learned. I pieced together what I could and called a few of them again.

Ashley, our nurse, said the doctor would be sending an appeal letter to our insurance company by Tuesday. They thought they might be able to get them to approve some of the denied medications. When I called on Thursday it had not been sent yet...maybe today. I am not expecting insurance to change their decision. I never thought I would be willing to pay so much only to stab myself over and over again! We will begin injections sometime in the next 2 weeks or so and I'm not expecting an appeal decision to be made by then. I will just keep price shopping for now. We have been surprised by how many things have worked out in our favor through this whole process, maybe this will surprise us as well!

On a more pleasant note, a good friend of mine made us this adorable bib :)

It may be a bit premature but she and her husband are moving to Canada (not because of the upcoming election) and she didn't want to to get lost in the move. Our collection of baby things has officially started.

- Emily

Insurance is a Beautiful Thing

Many of you have already seen my excited update on Facebook, but we got some amazing news last week! Probably the best news we have gotten ever in our journey towards a healthy baby.

We met with the billing department at The Fertility Center a few weeks ago. The woman who helped us seemed excited and told us we have great insurance that will cover most of our IVF cycle. This has happened a couple different times. They tell us nearly everything will be covered and then say none of it is covered when we remind them that we are not infertile. The billing ladies don't keep up on the medical side of things for obvious reasons, it usually doesn't change how they need to process insurance.  This time was different in that they had already sent the claim to insurance and it was initially approved. They did however still need to send in all of our clinical information. Our insurance company would review everything and make a final decision from there. She wrote out the total we would owe if insurance will in fact cover our cycle and the amount we would owe paying out of pocket...it was around an $8500 different!

We left the meeting expecting everything to be denied by insurance. Less than a week later, I got a call while I was at work...APPROVED! We will only owe around $500 for the rest of the IVF procedures. I normally don't answer personal calls while on the clock, but I recognized the number. I was so excited I had to tell the ladies at work. There were hugs all around. I realized then that everyone at work knew before Brian..whoops! This has lifted such a weight off of our shoulders and made this a much more pleasant experience. Insurance will unfortunately not pay for all of my injectible medications, which will add a pretty penny to our total, but we really shouldn't complain about that now. Our doctor is filing an appeal and we will see what they say.

Tomorrow will mark 4 weeks since RGI began working on our gene probe. We were told it takes 4-6 weeks for the entire process, meaning at any point in the next 2 weeks we will be getting ready to start injections. For now, we are celebrating insurance and counting our blessings! Good things are happening! :)

-Emily