Customize medications toward lifetime fertility cap in insurance?

I got screwed by a major prescription drug supplier during my first IVF cycle -- they told me my drugs would not cost against my lifetime fertility benefit but they did.
I am told I can ask my employer (I have employer-sponsored and funded insurance) if they can customize which drugs fall under the fertility maximum benefit cap. Has anyone heard of this or had success? Seems like a longshot but I am going to try.

Re: Customize medications toward lifetime fertility cap in insurance?

  • mbradfo2mbradfo2 member
    edited February 2021
    Preface: I do insurance coordination but my insurance did not cover IVF. So this is just from the knowledge of insurance in general.

    You'd probably have to look at the formulary and see which drugs (brand name vs generic vs compounded) won't hit your maximum benefit limit. They usually have a reference somewhere on their website, usually buried deep in the provider resources area. Then you would structure your cycle around the drugs that won't hit your limit... but I suspect there are some that will have no substitution or generic available. But it's always worth checking out.

    May I ask which prescription drug supplier? Feel free to PM me. I've used so many different ones over the years!
    ~~ Our Story in Spoiler! TW loss/child~~
    Fall 2012 -- started TTC
    Summer 2015 - no BFP yet, labs normal, referred to RE
    Fall 2015 - Summer 2016 - Further testing all normal. 3 IUI's -- BFN. Recommended move to IVF. Planned cycle for fall 2016.
    September 2016 - Surprise natural BFP. MMC @ 8 weeks. RE expressed confidence that we just needed the 'right' embryo.
    Fall 2016 - Spring 2017 -- Break from TTC
    June 2017 - Started IVF; egg retrieval for freeze all cycle. 9 mature eggs retrieved, 5 fertilized. 2 4BB embies on ice.
    August 2017 - FET transfer both embies. BFP.  Twin pregnancy confirmed by ultrasound. EDD 4/28/18
    September 2017 - Twin B stopped developing; Twin A doing perfectly! Graduated from RE @ 10 weeks
    March 2018 - Baby Girl born via C/S due to pre-eclampsia -- strong and healthy!

    TTC #2
    January/Feb 2021 - Freeze-all IVF cycle 
    March 2021 - FET of 1 PGS normal female embryo. BFP! Beta #1 156,  #2 472, #3 1241, #4 5268 EDD 12/5/21 - Christmas baby!

    "When all is lost then all is found."

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