Tricare and Infertility question — The Bump
Military Families

Tricare and Infertility question

Hello ladies,

I have a question we just got tricare std this month and we are thinking about either doing iui/ivf or injectible and bed. Currently looking for an RE. So once i find local RE where does he need to send the prescription?  He  might prescribe gonal, lupron, progestrone, ovidrel.

Some people say  if you do injectible and bed, tricare will cover all the drugs. So those who have done this can you please give me the steps you used. Thanks you ladies.

 

 

Re: Tricare and Infertility question

  • I did IVF at one of the military hospitals that does it.  Tricare's official stance is that they do not cover injectibles for any type of non-coital reproductive technologies. I'm sure somebody will jump in here with their wide range of experiences, but that's their official policy, so don't plan on any coverage there. The referral to the civilian RE I went to for a consult was covered and diagnostic stuff was covered, and I was able to get my BCP for suppression at the base pharmacy.  Everything else would have been OOP through a civilian clinic.
    Twin boys due 7/25/12
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  • We did injectables with timed intercourse tricare covered everything but copay. I don't know if matters but I am prime bi was sent out of town to a RE and was even paid mileage cause no RE near by. My RE called in meds to a mail order place I paid copay and was sent meds. All my visits at RE were 100% covered. 

    The way I understand it is tricare will cover as long as having sex for end result if do iui or ivf they don't cover anything but a few of the meds. 
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  • I think it just depends where you're at. I've done 5 IUIs at an MTF and everything was covered except the sperm washing, which we had to pay out of pocket for. I'll be doing IVF #1 in April and the only components covered are my meds, monitoring appointments, and ultrasounds (which I'm very grateful for). We'll end up paying about $7,000 out of pocket to the IVF lab. 
    TTC since 2007. Dx PCOS 6/2010
    4 unsuccessful rounds of Clomid
    Clomid 50mg - BFP #1 - February 7, 2010 Missed miscarriage March 25, 2010
    Clomid 100 mg - BFP #2 - October 28, 2010 Chemical pregnancy November 4, 2010
    IUI #1 - Gonal-F + Ovidrel = BFN
    IUI #2 - Femera + Gonal-F + Ovidrel + Endometrin = BFN
    IUI #3 - Gonal-F + Ovidrel + Endometrin = BFN
    IUI #4 - Gonal-F + Ovidrel + Endometrin = BFN
    IUI #5 - Menopur + Gonal-F + Ovidrel + Endometrin = BFN
    IVF #1 - Microdose Lupron Flare protocol = BFN
    FET = BFN - lost all remaining embryos
    IVF 2.0 - In progress. 20 retrieved. 16 mature. 10 fertilized with ICSI. 3, grade I embryos transferred, 7 made to freeze. Currently in the 2ww.
  • I think it just depends where you're at. I've done 5 IUIs at an MTF and everything was covered except the sperm washing, which we had to pay out of pocket for. I'll be doing IVF #1 in April and the only components covered are my meds, monitoring appointments, and ultrasounds (which I'm very grateful for). We'll end up paying about $7,000 out of pocket to the IVF lab. 
    Tricare isn't covering anything for you. Those meds all come from a grant. MTF == Tricare.  
    Twin boys due 7/25/12
  • We did IVF at both a MTF and a civilian RE...we used Freedom Fertility pharmacy and although our stimulation meds weren't covered, most of the others were. OOP we paid about $4000 for medication.

     

    Good Luck! 

    Baby Birthday Ticker Ticker
  • Ojo has provided the most straight forward, Tricare Standard policy information. Since you will be seen by a civilian RE through Tricare Standard, the anecdotal stories of what was covered or paid for at various MTFs is inconsequential to you.

    If I were in your situation, I would ask if the RE's billing office is familiar with Tricare. Coding seems to be a crucial part of maximizing what Tricare covers.

    Best of luck!
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  • Hi ladies,
    Thank you for all your input. I found an RE but he is not in tricare network and he takes Humana. I am in FL and they only have 2 RE in the network. Both of them their website do not say anything about infertility.

    lauren2-Are you at Fort bragg? I might have to come to NC and have iui.

    Can someone give me the phone/address where my RE will need to send the prescription of meds if i do injectible and bed. I am in tricare south.



    I came across this... it makes sense that they covered lauren2's IUI because in north they do cover.

     

    -----------------------

    DrTravisMcCoy

     I see a lot of Tricare patients, being near a naval base in Jacksonville, FL, and you should know that it can even vary if you're in the Tricare North vs South region. I'm currently in the South region (FL, obviously), but previously practiced in the North region (in KY). They have different rules and slightly different coverages. In the South for instance, they will not cover any of the cycle work that involves an IUI or IVF. This wasn't quite the same in the north region, and they often covered the process in an IUI cycle. FYI, we have to be fairly strict about the coverage, as we have had charts audited by Tricare, and have heard of them coming back to patients requiring that they repay what was spent (on gonadotropins, for example).

        Travis W. McCoy, MD, FACOG
        Reproductive Endocrinology & Infertility
        Florida Institute for Reproductive Medicine (FIRM)
        The Center for PCOS
        Jacksonville, FL

  • Like any other medications prescribed by a doctor off base, they can call them in to a local pharmacy or the mail order program, and in some cases, the base pharmacy, but most injectibles are not in the core formulary.  

    Please don't trust Google for researching Tricare coverage.  Their website is https://www.tricare.mil/mybenefit/ProfileFilter.do;jsessionid=T2kPtqnJJq1RbgZ667fvxQXN5HfsPNLFG2JyGTpkqxQhNJC92Hlg!1992934028?puri=%2Fhome%2FMedical%2FIsItCovered.jsp

    Their website allows you to enter your region and your status to get accurate information.  

    Please note this specific page on Tricare's website was updated 11 days ago, so the information is as up to date as you're going to find on the internet.  https://www.tricare.mil/mybenefit/jsp/Medical/IsItCovered.do?kw=Infertility+Treatment   

    You can also call Tricare to ask.  It's much better to hear things from the horse's mouth than to trust people online who don't know the difference between MTF services and their Tricare benefits.  

    Seriously.  Call Tricare. In the South region, they go by Humana Military Healthcare Services. https://www.tricare.mil/contacts/ 

    Twin boys due 7/25/12
  • imageMrsOjoButtons:

    I think it just depends where you're at. I've done 5 IUIs at an MTF and everything was covered except the sperm washing, which we had to pay out of pocket for. I'll be doing IVF #1 in April and the only components covered are my meds, monitoring appointments, and ultrasounds (which I'm very grateful for). We'll end up paying about $7,000 out of pocket to the IVF lab. 
    Tricare isn't covering anything for you. Those meds all come from a grant. MTF == Tricare.  

    Awesome thanks for pointing out my lack of knowledge. I'm just grateful I don't have to pay out of pocket for my meds.  

    TTC since 2007. Dx PCOS 6/2010
    4 unsuccessful rounds of Clomid
    Clomid 50mg - BFP #1 - February 7, 2010 Missed miscarriage March 25, 2010
    Clomid 100 mg - BFP #2 - October 28, 2010 Chemical pregnancy November 4, 2010
    IUI #1 - Gonal-F + Ovidrel = BFN
    IUI #2 - Femera + Gonal-F + Ovidrel + Endometrin = BFN
    IUI #3 - Gonal-F + Ovidrel + Endometrin = BFN
    IUI #4 - Gonal-F + Ovidrel + Endometrin = BFN
    IUI #5 - Menopur + Gonal-F + Ovidrel + Endometrin = BFN
    IVF #1 - Microdose Lupron Flare protocol = BFN
    FET = BFN - lost all remaining embryos
    IVF 2.0 - In progress. 20 retrieved. 16 mature. 10 fertilized with ICSI. 3, grade I embryos transferred, 7 made to freeze. Currently in the 2ww.
  • imagesummerof69:

    Hi ladies,
    Thank you for all your input. I found an RE but he is not in tricare network and he takes Humana. I am in FL and they only have 2 RE in the network. Both of them their website do not say anything about infertility.

    lauren2-Are you at Fort bragg? I might have to come to NC and have iui.

    Can someone give me the phone/address where my RE will need to send the prescription of meds if i do injectible and bed. I am in tricare south.



    I came across this... it makes sense that they covered lauren2's IUI because in north they do cover.

     

    -----------------------

    DrTravisMcCoy

     I see a lot of Tricare patients, being near a naval base in Jacksonville, FL, and you should know that it can even vary if you're in the Tricare North vs South region. I'm currently in the South region (FL, obviously), but previously practiced in the North region (in KY). They have different rules and slightly different coverages. In the South for instance, they will not cover any of the cycle work that involves an IUI or IVF. This wasn't quite the same in the north region, and they often covered the process in an IUI cycle. FYI, we have to be fairly strict about the coverage, as we have had charts audited by Tricare, and have heard of them coming back to patients requiring that they repay what was spent (on gonadotropins, for example).

        Travis W. McCoy, MD, FACOG
        Reproductive Endocrinology & Infertility
        Florida Institute for Reproductive Medicine (FIRM)
        The Center for PCOS
        Jacksonville, FL

    Yes, I'm at Bragg. I have everything done with Dr. Parker at Womack.  

    TTC since 2007. Dx PCOS 6/2010
    4 unsuccessful rounds of Clomid
    Clomid 50mg - BFP #1 - February 7, 2010 Missed miscarriage March 25, 2010
    Clomid 100 mg - BFP #2 - October 28, 2010 Chemical pregnancy November 4, 2010
    IUI #1 - Gonal-F + Ovidrel = BFN
    IUI #2 - Femera + Gonal-F + Ovidrel + Endometrin = BFN
    IUI #3 - Gonal-F + Ovidrel + Endometrin = BFN
    IUI #4 - Gonal-F + Ovidrel + Endometrin = BFN
    IUI #5 - Menopur + Gonal-F + Ovidrel + Endometrin = BFN
    IVF #1 - Microdose Lupron Flare protocol = BFN
    FET = BFN - lost all remaining embryos
    IVF 2.0 - In progress. 20 retrieved. 16 mature. 10 fertilized with ICSI. 3, grade I embryos transferred, 7 made to freeze. Currently in the 2ww.
  • imageMrsOjoButtons:

    I think it just depends where you're at. I've done 5 IUIs at an MTF and everything was covered except the sperm washing, which we had to pay out of pocket for. I'll be doing IVF #1 in April and the only components covered are my meds, monitoring appointments, and ultrasounds (which I'm very grateful for). We'll end up paying about $7,000 out of pocket to the IVF lab. 
    Tricare isn't covering anything for you. Those meds all come from a grant. MTF == Tricare.  

    Awesome thanks for pointing out my lack of knowledge. I'm just grateful I don't have to pay out of pocket for my meds.  

    Tricare does cover some of the meds....the stim meds are provided courtesy of grants. I thought that was interesting when Nurse D told me that!  So, when we cycled at Womack, we got most of our meds for free (the stim meds where given by Dr. P's nurse and all of the other "stuff" was provided by Freedom pharmacy (paid small co-pays).  When I cycled with a civilian RE, I had to pay for stims (majority of the cost), but tricare still picked up the majority of the other meds, minus the co-pay.

     

    Good luck with Dr. P, he's a nice guy. 

    Baby Birthday Ticker Ticker
  • You ladies are awesome. I will check with my civilian RE to see if they are familiar with Tricare Coding and also take benefits book with me.

    I will also call tricare this week.

    I am seriously thinking about coming to Fay I have family in Raleigh so driving to Fay will be a breeze. How hard is it to get an appointment?
  • imagesummerof69:
    You ladies are awesome. I will check with my civilian RE to see if they are familiar with Tricare Coding and also take benefits book with me.

    I will also call tricare this week.

    I am seriously thinking about coming to Fay I have family in Raleigh so driving to Fay will be a breeze. How hard is it to get an appointment?

    The waiting list is pretty long. I got referred to him last September, but didn't get into see him until December. I only got bumped because I had a second miscarriage while I was waiting for an appointment. Julie Anderson is the woman who makes the appointments for Dr. P, so you'll end up speaking with her.  

    TTC since 2007. Dx PCOS 6/2010
    4 unsuccessful rounds of Clomid
    Clomid 50mg - BFP #1 - February 7, 2010 Missed miscarriage March 25, 2010
    Clomid 100 mg - BFP #2 - October 28, 2010 Chemical pregnancy November 4, 2010
    IUI #1 - Gonal-F + Ovidrel = BFN
    IUI #2 - Femera + Gonal-F + Ovidrel + Endometrin = BFN
    IUI #3 - Gonal-F + Ovidrel + Endometrin = BFN
    IUI #4 - Gonal-F + Ovidrel + Endometrin = BFN
    IUI #5 - Menopur + Gonal-F + Ovidrel + Endometrin = BFN
    IVF #1 - Microdose Lupron Flare protocol = BFN
    FET = BFN - lost all remaining embryos
    IVF 2.0 - In progress. 20 retrieved. 16 mature. 10 fertilized with ICSI. 3, grade I embryos transferred, 7 made to freeze. Currently in the 2ww.
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