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Its the biggest scam. Price for meds are tremendously marked up if purchased through insurance vs. Out of pocket. Determine if it's worth paying oop for some to save your insurance coverage where it will go further.
This is what I had seen someone do in a news article I just googled. I might try this. But it really rankles me that they gave me a much lower price without insurance before I started the meds but could not give me the price with insurance bc they said they would not know until it was actially processed through aetna. It's like a bait and switch.
I would recommend purchasing meds out of pocket. I checked multiple pharmacies but ended up going with MDR. Their pricing overall was the best, they included all necessary peripherals, and delivery is next day. For same day needs Alto is #1. Good luck!
I recommend village fertility as a pharmacy. When I called with my prescription, they gave me the cost of everything with and without insurance.
Wow... America... just wow!! I paid £925 for all my meds for egg retrieval here in the UK. This is not NHS costs this is private costs to a private pharmacy.
This includes 3 Gonal F pens, 10 doses of Menopur, 5 x Orgalutran and Ovitrelle trigger. $33K is BONKERS even if that's not what YOU actually pay and that's what they bill the insurance company. Do you ever consider travelling for medical services as the prices I see here for fertility treatment and medication is seriously crazy. Sorry your system is so broken (no sarcasm here, I'm really sorry)
Super broken!
The CVS Caremark prices are so, so high, but I believe my 3 Gonal-F pens from CVS Caremark were around $8,000 (in 2021) charged to my insurance. You do have to figure out whether it makes sense to use your insurance benefits for prescriptions or do self-pay through other pharmacies and save your insurance benefits for the medical portions.
CVS Specialty has a partner pharmacy Encompass they can transfer your prescriptions to. The 3 Gonal F pens cost me about $2,300 through Encompass and there are many other similar pharmacies to compare prices. That of course is $2,300 out of pocket you’re paying vs just the copay utilizing your insurance, so it depends how generous your policy is and how many rounds you will need. Many of us with combined lifetime max do elect to pay for our meds to save the insurance for the medical costs.
Thanks for that info! It's kinda crazy your pens were only 2300 last year and mine were 17000!
If you call the CVS specialty prescription group and ask, they will provide you with the information for one of their subsidiaries whose pricing is significantly cheaper. I had some coverage for my fertility prescriptions and just picked out what had the best prices and used insurance on the ones it was worth it on and then went through CVS’s subsidiary for everything else that I paid out of pocket for and was able to save a lot of money that way.
Thanks! I wonder if they will let me do this retroactively since I've already taken the meds. But really good info to know for the future. I'll try calling them and seeing if they can let me choose.
Omg this is crazy. I have Aetna Open Access and I didnt have to pay this much. My out of pocket pay is about $70 per pen. I also ordered from CVS specialty earlier this year. In fact, i have one brand new pen left. Let me know if you want it, i can give it to you for free.
Surely! And you probably can reach out to your nurse too. When I was doing my retrieval I also had a bunch of menopur and pens left and I wasn’t aware of such groups yet I just gave them to my nurse. She said the fertility office also have like a bank for emergency use or for patient in need. Best of luck with everything!
You will pay much less OOP for meds than if you use insurance.
You will pay MUCH MUCH MUCH more OOP for anything non-meds (eg visits, X-rays, procedures, etc) than if you use insurance.
Have you considered freedom fertility? What size pens did you get? I get the 300 as they overfill each one so you get more medicine for 3 300 then one 900 for the same price.
Schrafts Pharmacy or OptimumRX were pretty affordable. Each IVF cycle was about $2,300 cash pay for all. Shipped overnight. Service was beyond amazing. They even had Vimeo videos for how to inject the meds.
Rising Star
I wouldn't using CVS. Not only pricing is ridiculous, their shipping and handling is also the worst. I also recommend Freedom!
Schrafts Pharmacy and OptumRX was Steller too!
Just leaving an update. After multiple calls with cvs and aetna, looks like the medication was in fact overbilled and I'm looking most likely at around 15k-16k for the meds (not 33k aetna said cvs had billed). They're working on the back end to fix everything so hopefully by next week i will know exactly how much i have left in my accumulator for my next round of egg retrieval. Assuming 15k is accurate, i spent nearly half my lifetime fertility benefit of 35k at kpmg just for the drug portion of 1 egg retrieval by using insurance at cvs. I've learned my lesson though and for the next one am going to go out of pocket and use one of those other pharmacies everyone has suggested! Hope any KPMGers who come across this post learn from my mistakes!
I used cvs Caremark and my gonal pens were about $850 each. Not sure why pricing is so different for others.
Thanks for the info! Yeah the price difference is ridiculous. My aetna rep said she had another kpmg client who only paid around 15k for their meds through cvs but had been initially charged 25k and credited back 10k for an overcharge. That's why the aetna rep asked me to see if there was some kind of overcharge. But cvs said that the prices were accurate on my account :( not sure why my prices are so different even from someone on the same plan as me.
We always used a place in Brooklyn called kings pharmacy. Way cheaper
I used alto pharmacy in NYC was significantly cheaper. OOP spent around 3k for all meds per cycle
I was on min. stim due to low AMH so probably you have a higher dose
I had 3 - 900ml Gonal F pens and it charged my insurance $10k. I paid $30 copay. The CVS lady I spoke with told me I had amazing prescription coverage, but my actual health insurance has been maxed out for infertility (15k lifetime which we blew through in a failed round *eye roll*)
Out of pocket payment will usually be lower than the price charged to insurance. For every med.
I used prudent RX with cvs specialty and I think they were 100% covered or just a few $100 dollars I can’t remember exactly but felt lucky to have that coverage
I paid cash and my meds were 7-8k first time and $4k this time (had some meds left over). I did freedom pharmacy first time and sands this time (my dr picked)
I'm in the same boat yesterday I called CVS specialty to see what price my injectables were going to be and they were charging my insurance $900 per injection. It's so expensive that it costs more to use my insurance for my 10 injectables than it would to pay out of pocket for my 10 injectables. The out of pocket pharmacies charge a cash rate of like 250 bucks per injectable or $2500 for all 10. It's insane and I don't think my insurance company has any motivation to negotiate a lower rate because my prescription insurance is CVS caremark. CVS caremark requires me to fill through CVS specialty pharmacy. How is this legal??? I think what we are going to do for my own sanity is to just not fight it. I'm going to max out my $7500 rx benefit and pay for six of the injectables and then pay cash for the other four injectables. What a scam.
Sometimes it’s cheaper not to use insurance. I ended up using alto for one of my rounds and the total cost of my meds came out cheaper than my round with insurance. It was about 2500 difference. Insurance route always almost charged double, but then a discount. If your coverage is by lifetime dollar, then 1 round pretty much wipes your entire coverage plus out of pocket.
Pro
Is your insurance not covering anything? What is your cost sharing like? By “charged around 33000” are you saying that’s what they billed insurance or that’s what they are expecting you to pay? What is your out of pocket max? I only had to spend $5k total because my Aetna OOP Max was $6k and the meds wiped that out.
@kpmg3 you can call your aetna assigned fertility specialist to see how much is used up. Or I think you can also look online at your accumulator on your account, at least thats what the aetna lady told me on the phone.