New here - qq on IVF drugs - I am charged over $3500 for the first round of IVF drugs. I was told this includes deductible and copays for a variety of the included drugs. Are these out of pocket expenses reimbursable under the pathway program? I read that deductible and copays are patients responsibility...is it normal that we got to shell out this much for drugs even with this pathway program in place? TIA

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You should ask if any meds have alternatives. Every IVF doctor is different and some may have medication preferences that are not covered as well as others. Get as much info as you can to see what options you have and if that could reduce your out of pocket expense. Your annual out of pocket maximum will come into play as well.

I'm seeing some questions about the 50k as if the reimbursement is for 50k.

The 50k is one large pool of benefits that includes any expenses you are reimbursed as well as what is paid out by medical/pharmacy benefits. You might use up $20k for 1 round of IVF between meds, retrieval, implantation, etc.

The exception is that any meds/procedures not explicitly part of infertility treatment will fall under your regular medical coverage and do not count towards the $50k.

Adoption or surrogacy fees also fall under the same $50k bucket.

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OP : please update here once you get any answer.

F

Specialty drug co pay through CVS was like 800 per rx I believe. So you pay those out of pocket

OP, unfortunately I see this over and over in the FAQ PDF. “Please note: Deductibles, co-insurance and copays are the participant’s responsibility”

Ongoing ultrasounds and bloodwork, egg retrievals, transfers, etc. I also learnt PGTa prep and testing isn’t covered.

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There are not two separate payouts between P2P and insurance - it’s one bucket.

Yes unfortunately I had the same issue. We also "need" to go through caremark not another pharmacy so keep that in mind too.

The medicines will need to come from CVS specialty pharmacy (and CVS Caremark pharmacy benefits) if you are using the EY Pathways to Parenthood benefit. Your amount of $3500 out of pocket includes your deductibles and copays. Mine was $3100. Remember, this is not the amount billed to insurance. That amount will be higher. Mine was $5500. That $5500 will be deducted from your $50,000 lifetime pool. You should ask the fertility coordinator (like Optum fertility solutions) or your insurance how much of your lifetime pool is used up until now (its called accumulated value).

Correct. PGT-A and Biopsy aren’t covered.

I would say bill our insurance for the meds and don’t do out of pocket. You’ll have to meet your normal plan deductible before anything is pulled from the $50k lifetime fertility benefits.

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