Question for EY folks - does 10k fertility benefit not cover Ovidrel completely? CVS Caremark says insurance covers only minimal and rest is all out of pocket! Then what goes in 10k benefit?

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Oh boy, the medication stuff and insurance. I have spent HOURS on the phone figuring this stuff out (well still kind of trying to I guess lol). Send me a message and I'll share my experience; it's way too much to type out.

But basically, if you go through insurance, the price of the IVF medications is so high/inflated that one round will wipe out the $10k AND you'll have to pay a bunch out of pocket. I ended up going with a different specialty pharmacy and not using insurance (since we can only use CVS) and their out of pocket price was actually less than the co-pays with CVS.

I agree with EY1... I ended up using my $10K meds limit on my 1st cycle itself. And after exhausting my $25K limit, i switched to different insurance under MA health connector.. For a brief period, i also purchased meds from another speciality pharmacy where meds OOP cost was cheaper than insurance co-pay for caremark

Indeed, insurance is rigged, and they have their own list of what they would consider speciality drug and what they won’t for $10k benefit purpose. It had been more than 2 yrs when I did my 1st cycle with CareMark so don’t remember exact details of when $10k would kick in, however, I would suggest checking with WinFertility if that’s still the company that offers these benefits, per EY’s plan. Like I said before, I am no more on EY’s insurance plan, because I have exhausted all lifetime coverage. Feel free to PM me if you would like to talk in detail or if u have any questions on this journey. Good luck !

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