Mar 08 2011
IVF requires a lot of different drugs. The Man and I have prescription drug coverage, but just like everything else, coverage has been cut and more hoops have been added to make getting drugs somewhat of a chore. My IVF angel (aka nurse, liaison, counselor, etc.) , Kris, made obtaining the drugs so very simple. At first, we were planning on just using the mail-order pharmacy recommended by WSU, because that pharmacy specializes in the drugs necessary for IVF – they understand the timelines and urgency involved and are easier to work with. However, when the pharmacy contacted me for help in dealing with my prescription drug coverage company, I knew we were in for a bumpy ride. I ended up having to call the member services number of our drug insurance place and talking to an apathetic service rep who basically told me that my two options were 1)Mail order the drugs directly from them or 2)Pick up the drugs at my local pharmacy. I didn’t even know what drugs I needed, or if my insurance would cover them. I foresaw a long, confusing process of getting the list of drugs from WSU, going through it line by line with some rep, and then putting in the mail order forms for every drug I needed. However, one phone call to Kris cleared all of the worry and hassle away. When I told her that my insurance company was making me order through them, all she said was “OK, my dear, no problem. Which company is it? And is the account in your name or The Man’s?”
Of course, the next day, some “helpful” person from a branch of my prescription drug place called to let me know that my claim was denied “by the insurance company” and my doctor was appealing. I said to her, “I thought you guys were my insurance company”, and her response was “Oh no, we’re just the distributor.” And, at that point, I had no idea what was going on, who I had insurance through, what my name was, or what. I called Kris again, and she assured me that they would file appeals on the decision. It turns out that we won appeal…on three of the drugs I would need. That left three other drugs that The Man and I had to pay for out of pocket, not to mention the progesterone-in-oil injections I’d need to take for a minimum of days after embryo transfer (and if I got pregnant, I would be taking PIO for 10 weeks or more). The three that ended up being covered were no hassle – they called us, we paid the remaining balance that wasn’t covered, and they shipped the drugs. The three that weren’t covered were a bit more of a hassle.
First of all, I didn’t realize that the pharmacy was waiting to hear from me to tell them to go ahead and process the order. I assumed Kris was going to handle it again. After I talked to her, she told me to go ahead and call, so I finally called them about two weeks before my cycle was set to begin. That conversation was really fun. It went sort of like this:
Me: *dials the number clearly printed on the letter I received, telling me to dial this number for my drugs*
Authorization Rep (AR): Thank you for calling Pharmacy’s Authorization Department.
Me: Uh, yeah, I have this letter that says my claim was denied. However, I still want to order my drugs, so that’s why I’m calling.
AR: Your name and date of birth, please.
Me: *gives her that stuff*
AR: Well, this claim was denied. Your appeal was also denied. I mean, this goes all the way back to March. So, Insurance Company is not going to pay for these prescriptions unless you submit another appeal. If that gets denied, then you’ll have to pay out of pocket.
Me: I don’t want to appeal. I know the drugs aren’t going to be covered. But, I still need them. I want to order those drugs. I only called this number because it was the number the letter I received told me to call to order drugs.
AR: Oh, all right. Let me get you to a pharmacy representative.
AR: Jas, I have Pharmacy Rep (PR) on the line, she is going to assist you.
PR: OK, so you need to order some medications? Do you know the names of the meds?
Me: I don’t know…my doctor told me you would still have the prescriptions on file. I have some letters here, let me see if I can find the names…OK, I need Follistim, HCG, and Menopur.
PR: All right…uh…those are specialty fertility drugs. Let me get you over to the specialty pharmacy.
PR: Jas, I have Specialty Rep (SR) on the line, she is going to assist you.
SR: OK Jas, you need three different medications?
Me: Yes: Follistim, HCG, and Menapur.
SR: And do you know your dosage and quantities?
Me: What? No. My doctor told me that he submitted the prescriptions and that you guys should still have all that on file. I never saw them.
SR: OK, hold on for a moment.
SR: Jas, thanks for waiting. I have your prescriptions here. I will go ahead and submit that order for you right away.
Me: I need these by May 5, is that going to be a problem?
SR: Oh no, ma’am. We can overnight them.
Me: And when I call for refills, who should I call? Because the number I had wasn’t right.
SR: You call us here in Specialty. Here’s the number: 800-xxx-xxxx. That gets you right to us.
So, I thought that was over. Except, three days later, someone called to tell me exactly how much these uncovered drugs were going to cost. The Man and I are not stupid; we know IVF is expensive. However, we were led to believe (by everyone we talked to, including our doctor’s office) that the price of drugs per cycle would be around $4000. Let’s just say that it ended up being more than that. The final cost for these uncovered drugs ended up being more than we thought we could afford, leading to a night of totally freaking out for both of us. However, after we both calmed down, The Man looked at our finances again and we figured out that we could, in fact, afford our drugs. Barely.
Then the pharmacy called two days before they were supposed to ship the drugs to let us know our payment didn’t go through. That was another fun evening of a low grade freak out fest before we figured out where the missing money had gotten to, fixed everything, and asked the company to run the charge again. The rep assured me they would run it that night and it would ship that night or the next day.
When I called the next day, the rep told me that the charge hadn’t been run, for no good reason that she could see. She was going to send it over again and also e-mail the supervisor of the billing department to get it processed ASAP. It was now May 3. I HAD to have these drugs by May 5; they were all the stimulants I needed to begin my cycle. The three drugs I had sitting around were not to be used until later. Lucky for me, when I called again on May 4, the rep assured me the payment had gone through and the drugs would be overnighted to me. I would have them when I got home from my doctor’s appointment.
The doctor’s appointment was the blood work and ultrasound I needed to do before we could officially begin our IVF cycle. If everything was clear, that evening I would begin my stimulant injections.
The full list of drugs I needed for my cycle:
- Menopur (follicle stimulating hormone, injection)
- Follistim (follicle stimulating hormone, injection)
- Ganirelix Acetate (ovulation suppression, injection)
- HCG (“trigger shot” meant to force eggs into the last stage of maturation in preparation for retrieval, injection)
- Methylprednisolone (low dose steroid, pill)
- Doxycycline (used to help prevent infection during egg retrieval, pill)
- Valium (taken on the day of transfer, I’m sure to help keep me confined to my bed, pill)
- Progesterone In Oil (used to support pregnancy, injection)
The IVF Series