How can you save money on fertility medications for in-vitro fertilization (IVF) and other assisted reproductive technologies, like intrauterine insemination (IUI), egg freezing, donor eggs and so on?
We’ve been hearing a lot about rising costs for these procedures, and particularly about the medications, despite insurance. A couple of stories came our way. This post is the result.
Originally intended to share the practices at a specific national specialty pharmacy, research for this piece uncovered these practices happen at multiple specialty and fertility-specific pharmacies.
I deleted the names of the insurer, pharmacy and employer who supplies the infertility benefit, because these stories were so similar to other stories online with other insurers and pharmacies and employers. As in many things in health care, it’s not clear who’s responsible for these policies: The insurer, the supplemental fertility benefits insurer, the pharmacy benefit manager, an employer who chose a plan without fully understanding the implications, or some other cause.
Rather than holding up these entities as villains, the purpose of this post is to make clear what happens, and to present alternatives. Also, as always, we are not giving any medical advice here.
And as always, our deepest thanks to our community members, who contributed their experience and wisdom.
A Facebook encounter, and a story
A friend who knew of our interest in this tagged me in a discussion on a Facebook group about infertility. I had a conversation with one of the women, and asked her to tell me her story. Here it is.
“I would like to share about my experience with my insurance infertility benefit. I reside in NYC and have coverage with (name deleted) through my husband. Our plan has a $20K lifetime max for all fertility.
“In December 2018, we were recommended to do IVF for our infertility. This was the first time we’d used this benefit so we had the full $20K. After the requisite testing, we proceed with IVF in April 2019.
“Our clinic sent our medication prescriptions to the (name deleted) Specialty Pharmacy. When I called the pharmacy to see how much it would cost, they told me I would have $0 copay but that the medication for once cycle of IVF would take out $13K of our lifetime max.
“I called some other specialty pharmacies and was informed that, out of pocket, the same medication would be about $5K. I called the insurance company and asked if we could pay out of pocket and then submit for reimbursement. We were trying to preserve our lifetime max for the IVF procedures.
“The representatives I spoke to were highly uninformed about my fertility benefit, and each time I called, I had to explain the benefit to them. They told me to use an in-network pharmacy and then submit for reimbursement. They said it would likely be covered but that they could not say for sure until I submitted the paperwork. So, we proceeded with this plan.
“I submitted the forms for reimbursement promptly during April 2019 and was informed that it would take at least 30 days for them to be reviewed. Meanwhile we started IVF cycle #2, planning to submit the medication again for reimbursement.
“During this time, I was following up with the insurance regarding our claims, which were still pending. Finally, last week I called back to check on my claims. They had been denied.
“It took the reps I spoke with, including a supervisor, a long time to figure out why. The reason was because we are only allowed to use the (name deleted) Specialty Pharmacy to fill fertility medication. So, the insurance company sets the lifetime max, then they set the price of the meds, then they limit you to their pharmacy. It feels like a scam. We will continue to pay out of pocket for our medication because doing so will help our lifetime max go further.”
I asked her what medications she used, and she said, “Gonal-F, Menopur, and Cetrotide.”
Another woman’s experience
Separately, another woman told a similar story.
“I’m in my first round of IVF.
“I’m on regular, boring meds for a first round attempt.
“The (name deleted) insurance I have has coverage for $10,000 of fertility meds, lifetime.
“To date, I’ve ordered these meds, each with a $75 copay per medicine:
– 2 injections of ovidrel 7500 IU hcg ($63.53/each)
– 11 menopur 75 IU injections
– 11 Gonal-f RFF 300 IU pens (quoted as $6606.20 today)
– 5 cetrotide injections
– 1 novarel injection 10,000 IU hcg
“This week we reordered these:
– 3 Gonal-f RFF 900 IU pens
– 12 menopur 75 injections
“Last night with the reorder for the upped dosages I received a phone call asking for just shy of $4,000 to be paid because I HAD ALREADY MET THE MAX LIMIT of $10,000.
This was at an extremely time sensitive point in the process of IVF, we had no choice but to pay the surprise $4000
or risk wasting the entire cycle. It felt overwhelming and predatory.
“Shocked, given that there are price sheets all over the practice about how the average price for meds out of pocket for a cash-pay patient is $3-6K — I contacted the financial wizard at the (name deleted) medical practice.
“She set a FIRE ablaze today trying to figure out costs and how this happened. The pharmacy, (name deleted) Pharmacy, is claiming they can’t offer a breakdown of prices. They say it is proprietary. She was able to keep nudging people via the insurer and others to get the few prices above.
“So, with my super plush supplemental insurance add-on via (fertility benefits provider name deleted) to my (insurer name deleted) insurance plan from (employer name deleted) — I was *required* to go to (name deleted) Pharmacy.
“(name deleted) Pharmacy then upcharged the cost of pen compared to what they offer online to my insurance.
“My total cost for IVF meds is just over $14,000.
“The practice has stated they normally would alert a patient taking my meds the out-of-pocket costs for a cash-pay patient would be $4-5K.”
(Update: One woman reported that the patient financial navigators at the clinic she uses — UCSF Center for Reproductive Health — recommended from the outset that she look into self-pay for medications. Others at other clinics reported that they were told they could not get the cash-pay deals until they had expended their insurance — at the higher rate, of course.)
How does this happen and what can you do?
These two women are not alone — internet infertility forums are full of people telling basically this same story. So what can you do?
First: We are not dispensing medical advice. In this, as in all things, do your homework and be wise. Consider the source of information: If someone’s telling you to buy your medications from them and only them, do they have pristine and honest information?
We have heard a lot about people outside of the infertility world whose medications cost more with insurance than they would without insurance.
That’s right, put away your insurance card and pay cash, and save a ton of money.
IVF medications must clearly follow the same rules of the marketplace: Opaque and confusing pricing policies make the entire process murky. Additionally, most of us with insurance assume that our insurance policies uniformly give us access to the lowest price available. That’s no longer true — so pay attention.
Other common IVF medications: Progesterone, Lupron, Ganirelix, Follistim, Clomid, Letrozole, Ovidrel, Serophene, Bravelle, Femara. Here’s a fuller list of medications and their functions. This Wiki on Reddit’s infertility subreddit is also very complete, with names of medications and other useful information.
Before buying any medication, we advise that you ask the seller, “What will this cost on my insurance? What’s the cash price?” Ask several providers, so you can compare. Prices vary widely from seller to seller.
We don’t recommend any provider, but anyone looking for IVF meds might want to know about ivfpharmacy.com or ivfmeds.com or fastivf.com or vascorx.com. We have also heard people say they bought medications using goodrx.com, which is not specialized for fertility. GoodRx also has a “membership” program, which costs a monthly fee but may deliver lower prices.
Don’t overlook Costco. In our experience, they often have the lowest prices for non-fertility-related medications. In my Costco, you don’t have to be a member to use the pharmacy, but members get lower prices than non-members.
Here’s a page on Reddit of pricing information for common medications, together with a spreadsheet giving pricing information and contact information from 2017 for common medications from 10 U.S. pharmacies and one Israeli pharmacy.
We have heard of people buying medications overseas. Here is a page from a British pharmacy with prices.
Ivfprescriptions.com is in Israel. They have brick-and-mortar pharmacies in Israel and the U.K.
Here is a page on Reddit about buying medications in Mexico, along with the info that many reproductive endocrinologists want you to buy your medications from the pharmacies they approve — which would tend to lock you into the arrangements described by the two women above.
Update: After this post went up, we heard from several other women:
“Sending out a big ole thank you to everyone here that’s suggested GoodRX! I’ve never used it before, although most of my meds are out of pocket, so I’m not sure why… Rookie mistake. 🤷 Anyway, we’re trying Vivelle patches for FET #3 & I almost cried when the pharmacy told me the near $600 price tag for the 7 boxes I need. Thankfully my insurance covers 2 boxes, but that still left around $400 due for the remaining 5 boxes. But with GoodRX I was able to get all 5 boxes for $148… Crazy!”
“Where did you find them for that cheap!?! I used goodrx to look too but only found them for like $130 a box at the lowest!! I was only able to find the generic for as cheap as you got it ”
” I lucked out with GoodRx for Letrozole! I had paid around $180 for 10 pills, 2 cycles. A doctor I don’t normally see suggested it to me at an appointment, and that next cycle was able to get it for $6! I think I scared the pharmacist when I started crying! 😂”
“I live in Israel and just paid about $8 dollars for all my IVF meds. Maybe I should send my extras to you all! Happy to help out if it’s legal.”
Getting medications from other women
While it is illegal to sell these medications, they are available online at various sites. One woman wrote: “My clinic has unofficial Facebook groups that I bought all of my meds from….I saved thousands!”
It may also be illegal to give unused medication to others to help them save. If you’re considering donating, buying or selling, you should be certain you understand the laws of your state or country, and be clear about any potential consequences.
We have also heard that some fertility practices have a giveback program, or you can donate to a prescribing doctor who can control where they go.
Be careful: Do your homework
WINfertility, one of the providers of fertility benefits to employers, has a full page of caveats about why not to buy from online pharmacies, why not to buy overseas, why not to accept medications from other women, why Big Box stores may not be a good route, etc.
Of course, being cautious about where you buy medications is always a good thing.
Of course, WINfertility would like you to buy your medications from them.
It is important to note, as WINfertility does, that you and your clinic want you to be using good medications. If you buy on the black market, or take someone else’s unused medications, it’s possible the medications have not been refrigerated, or have expired.
It is also possible that if you buy from an online pharmacy, you won’t get the same thing that you would from the high-priced one your insurer sends you to. And it would be a huge pain to go through the entire process with bad medications, which is one reason the clinics try to control access to medications.
We’ll say it again: Do your homework.
Other options for dealing with the costs
We have also heard people saying they are asking for “point of sale” discounts or rebates on infertility and other medications. We don’t have a lot of data on this, but it seems worth asking.
In general, asking for a cash price might open a lot of doors.
Some employers offer an extra fertility benefit that goes beyond standard health insurance. WINFertility is one, and Progyny is another. These fertility benefits may lock you into using a particular pharmacy, so it makes sense to ask questions.
Clinics often have their own financing options. Some people use Lending Club for financing.
Some people decide to go overseas for treatment. Again, we don’t make medical recommendations, but we are aware of companies that will help assess and arrange such efforts, for example IVFTraveler. As in everything, do your homework.
Infertility treatment grants and scholarships from Resolve, the national organization for those with infertility
Infertility financing options, also from Resolve
Facebook group Matt and Doree’s Eggcellent Adventure has a robust discussion of various issues related to infertility. You can find their podcast here. You can find their list of resources here.
The F**k Infertility blog has some research, not especially fresh but thoughtful.