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.
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| 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
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