Insurance ?

violetmarie61516

I went to pick up the first prescription of Vivelle and it was for 16 patches.  The pharmacist said that my insurance will only cover 16 in a 30 day period.  My protocol has me starting with 1 and increasing to 4 every other day.  I will need 19 patches just to get me to my CD13 ultrasound before our FET and I'm supposed to continue 4 patches every other day until beta and if we are pregnant, up until around 10-12 weeks.

I'm wondering if anyone has had experience with this and how they got their insurance to cover it?  They are covering it, at least some of it, because it's used as HRT but I'm just on a higher dosage protocol for the FET process.  Do you think I would be able to get them to cover more?

DoublePortion

Does your insurance cover IF? If so, your dr may be able to get it preautorized. I have no IF coverage and my insurance took like maybe $10 off the cost each time I got a refill of Minivelle. I always suggest that if you have a GYN that you have a good relationship with to call them and ask for samples. For my IVF my GYN gave me 12 Vivelle patches.

ETA: I'm not sure if Vivelle offers it, but for Minivelle there was a coupon available that could be used like every 25 days or something like that. So I'd get what I could using the coupon and then do a refill with my insurance until I was eligible for the coupon again. This may be something only a specialty pharmacy would know about though.

brooklynesque

When I cycled I no longer had fertility coverage and was dealing with similar constraints. I ended up having to pay for a lot of the Vivelle patches out of pocket. You might want to let your RE know that you will only have partial coverage on the patches. It might make them decide to adjust your protocol to include more pills (which are cheap) and fewer patches.

Twinkie0612

I just talked to Dr. W today and expressed my concerns about estrogen patches (I have stupidly sensitive skin, bandaids will give me a large itchy welt that lasts a few days) and he said that they are starting to prescribe estrace more since vivelle is getting so expensive. Maybe they can adjust your protocol to include some estrace?

poohniki

I was on one vivelle patch a day though out my FET cycle. I had to get special approval from the insurance company- it was more of a problem at the pharmacy and I was even given instructions on how the pharmacist needed to enter it into the computer. Good luck

violetmarie61516

Thanks ladies.  I'm nervous to switch to Estrace because that's what I was on for my IVF cycle and it did nothing for my lining.  I will know if this works at my u/s next week but for now I want to keep the patches.  I don't have IF coverage so I know they are covering the limited amount because they probably think I'm using it for Hormone Replacement Therapy but I may still try to have them do a prior auth.  What pharmacy did everyone find it at the best price?

sarahjeri

We found that CVS or Walgreens had better pricing for hormone meds.  Also, you might want to call your insurance company to see if they'll approve the remainder.  Just tell them that is what your doctor said you need to do.  I've had success with getting things paid for just by making a call.

chicagobride_07

My RE had me use delestrogen. Is this an option for you that might be covered by insurance? It is an IM injection and worked well for me.

violetmarie61516

@Chicagobride_07  We are going to stick with the Vivelle dots this time.  Hopefully it does the trick.  I used oral and vaginal Estrace last time and didn't respond well.