Customize medications toward lifetime fertility cap in insurance?

tangerine32

Hi,
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.

mbradfo2

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!