TTC After a Loss

I'm either ignorant or just stupid....kinda long

First, let me just say that I don't know why, but I guess I'm just clueless about the price of prescriptions because I was in for quite a shock this morning when my pharmacy called.

As I said the other night, my doctor prescribed progesterone for me. Long story short, the pharmacy had three days worth-but the doc ordered a months worth for me. When I picked it up, they didn't charge me anything because it wasn't the full prescription. They said it would be ready today. I got a call on my way to work this morning from the pharmacy. She told me that my insurance doesn't cover it and that it costs $462.00..... Indifferent

I'm sorry, WHAT? 

Yeah, she said she wanted to call me because it was so expensive and she said that the doctor's office should've gotten this all taken care of ahead of time. I called the doctors office and they basically told me, "insurance doesn't typically cover INFERTILITY....." and she said it like she was telling me I had cancer or something. I told them I can't afford almost $500 a month for a prescription-so they said there may be one more option they can check on. I'm supposed to call them back tomorrow and get this all figured out.

I'm so disappointed. DH is too. When I came home and told him all this he got upset and told me I need to find a new doctor because they're not "willing to help" me. I don't know. I just don't know what to do. I was so hopeful about the progesterone. Now I don't know what's going to happen.....Sad

Re: I'm either ignorant or just stupid....kinda long

  • Oh my goodness....I had NO IDEA it would be that expensive!  What in the world?!?  I'm so sorry you're having to go through this.  I hope that your doctor can figure out the "other option" that he mentioned.  Good luck, and keep us updated.
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  • Is there no generic?  The generic for Prometrium is $10 on my insurance, and costs less than $50 out of pocket.  Granted, this is for a 10 day supply, but it still would be far cheaper than what you got.
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  • Wow, thats a lot of money. Fingers crossed for you that they get it all figured out.
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  • I'm hoping to find all this stuff out tomorrow because I didn't have a whole lot of time to talk to anyone since I was on my way into work.

    I have one more day left of it...and the lady at the pharmacy said I wouldn't have to pay for the three days worth that they gave me, so that's good. But I don't know, as with all prescriptions, I just thought it would be covered and I'd have to pay maybe like $30 or something. Not almost $500!

    Now, what's Prometrium? I haven't even heard of that. My doc has me on Crinone 8%. And the nurse who was all blaaahh with me about infertility was just like "I mean, Crinone is usually what we use...it's the most common." Ugh. 

  • Crinone, Prometrium and Endometrin are the 3 brands of suppository Progesterone.  I've used Endometrin and my insurance covered it even after my infertility lifetime max was used up.


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    2 years, 2 surgeries, 2 clomid fails, 2 IUIs, 1 loss, IVF #1 - 10/25/10 = BFP!, DS is now 3.5yrs!
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  • imageL&R70707:
    Crinone, Prometrium and Endometrin are the 3 brands of suppository Progesterone.  I've used Endometrin and my insurance covered it even after my infertility lifetime max was used up.

    Thank you-that's good to know. Did your insurance cover all of it or did you still have to pay something monthly?

  • O man, I'm sorry!  I hope they can work out an affordable alternative for you!
  • That's ridiculous that your insurance won't cover any of it. I hope they can find a more affordable alternative for you!
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  • Gosh that's insane! I'm surprised insurance doesn't cover that. hopefully they figure something out!
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  • The Prometrium I took was in pill form, not suppository.   It's also prescribed (in 10 day lengths) to make AF come when she refuses. 
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  • Wow that is a lot of money, I hope it all works out!
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  • Okay, I decided to look it up. Our prescription card is through Medco, so I looked it up on their website and they say it will only cost me $109 a month and that insurance will cover $256. Now I want to know what's going on.
  • Thats what my ins. said when I needed it to help support the PG (it didn't help I still m/c).  When they said they didn't cover 'infertility' I was like ... um I am pg! 

    It ended up a pharmacist in the area was able to compound suppositories (i guess make them from scratch) for me they were messy but only cost my 30 dollars for 30 of them.  Maybe you can ask your dr. if someone in the area can do that. 

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  • I have Medco too - call and ask, they're usually really great on the phone.

    You could also ask your doctor about OTC progesterone cream - I don't know how strong it is, but the doula I used with DS recommends it for all of her clients who have m/c'd.

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  • imagefrogyie:

    It ended up a pharmacist in the area was able to compound suppositories (i guess make them from scratch) for me they were messy but only cost my 30 dollars for 30 of them.  Maybe you can ask your dr. if someone in the area can do that. 

    This.  My compounded suppositories weren't covered but only cost me $42 for 30.  I just looked it up because they're still in my fridge :( 

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  • imagefrogyie:

    It ended up a pharmacist in the area was able to compound suppositories (i guess make them from scratch) for me they were messy but only cost my 30 dollars for 30 of them.  Maybe you can ask your dr. if someone in the area can do that. 

    This.  My compounded suppositories weren't covered but only cost me $42 for 30.  I just looked it up because they're still in my fridge :( 

    ___________________________________________________________________________________________________________
    BFP #1 3/27/10 - mmc discovered 5/20/10 at 11w2d - d&c 5/21/10
    BFP #2 11/6/10 - EDD 7/19/11 - Beta #1 @ 13dpo, 104 - Beta #2 @ 20dpo, 3400s
    BFP #3 4/24/13 - EDD 1/8/14 - Beta #1 @ ?, 33 - Beta #2 @ 4 days later, 260
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  • hopefully I will have some answers tomorrow...I'll let you guys know what I find out.
  • Oh my! That is incredibly expensive! Holy crap - I would have never guessed (so no, I do not think you are stupid or ignorant).

    I hope your doctor is able to offer another practical solution for you.

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  • imageTeacherVicky:

    Oh my! That is incredibly expensive! Holy crap - I would have never guessed (so no, I do not think you are stupid or ignorant).

    I hope your doctor is able to offer another practical solution for you.

    Thank you! I hope so too. I printed out information on three other progesterone supplements that are cheaper. I'm gonna call the doctor tomorrow and then hopefully I will be getting my prescription filled. If not, then tonights my last night of using it. It was fun while it lasted....blah. 

  • Ugh. I am so sorry. I hope they can give you something that is more affordable and just as effective.
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  • you should check also with your state- some states its mandated for insurances to cover infertility testing and treatment- i know thats the case fr CT
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  • That's some crap.  Call Medco tomorw! Good luck!
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  • Can your dr write it off to the insurance companies as something for your menstraul cycles rather than infertility? There as got to be another use for progestrone that you can squeak by on.
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  • How do you feel about shots?  PIO is cheap- mine was $10 for a months supply and I have some C.R.A.P. insurance, that's for sure.

    I used Endometrin in another cycle which wasn't covered so it was $3 per dose-  I don't know about Prometrium though.

    I live in NE, and infertility is not covered unless your employer is awesome and requested it covered on the plan (mine didn't and won't, so not awesome)  We're completely OOP so I look at the cost of everything!

    Good luck

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