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Aetna Specialty pharmacy - Rip off

kandoskandos member
in Infertility
Hi ladies
I am 33 year old and have Aetna insurance via my employer with a Max life time limit of 15k including IVF/IUI and Fertility medications. 

We are doing IVF with FET and since I knew there is an Aetna Specialty pharmacy so I asked my doctor to order the medications. Gonal F, Menopur, Lupron and Ganirelix thru them. All these insurance paid for plan costs around 8k leaving minimal out of pocket for me around $150 but deducted from 15k limit for any IVF treatment which I believe leaves me with just 7k. I believe it was a rip off and I could have rather easily ordered these medications from outside out of pocket like ivfmeds.com for $2400.

Would like to know if anyone had similar plan and how much they ended pay paying?
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Re: Aetna Specialty pharmacy - Rip off

  • Holls214Holls214 member
    Yeah that’s expensive. I paid for my meds out of pocket at our clinic and they were about $3500 +\-. 
    TTC 4 years. 7 failed IUI's with either Clomid, Femara and/or Trigger Shots. Started IVF journey in February 2017. Polyps removed in May. 1st IVF Transfer September 26th. BFP. Expected due date 6/14/18. Baby boy born 5/25/18 at 6 lb 9 oz. My bundle of joy. 
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  • mcgeevamcgeeva member
    That sounds about right! I was told by shady grove to find out what they charge insurance because it may be cheaper to pay for the stims out of pocket and save the rest for IVF which did make sense. The pharmacy also told me the deal insurance has with pharmaceutical companies is to charge 2-3 times more for the drugs when covered by insurance. It sucks but honestly everything with IVF is costly, rarely covered and always a fight. Can you send the drugs back and pay out of pocket?

    Married: 5/09 ~ TTC Since: 10/10 ~ PCOS ~ Progesterone from 10/10 - 2/11 ~ HSG on 3/18 - Clear ~ Started Metformin 1000mg & Clomid 50mg 2/11 ~ Metformin upped to 1500mg 4/6 ~ 6/7 Now going to SG and put on Clomid, Ovidrel, Gonal F, Prometrium, Estrace ~ IUI #1 7/2 = BFP!!!!!! March 6th our little man was born. 

    6/17/13 - Ovidrel, Follistim, Prometrium ~ IUI #1 7/2 = BFP! March 17th our St. Pattys day baby arrived

    10/29/17 - Started process for IVF, got pregnant & miscarried a 2nd time since summer. 2/22 started stims - Menopur, Gonal F, Cetrotide - retrieval 3/6 - , PIO, estrace 3xday - FET 4/18 = Beta 1: 616; Beta 2: 1342 = BFP 

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  • kandoskandos member
    No they won't accept the drugs back once shipped out. So I guess I will pay for whatever it costs hoping it works out all in the end.
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  • mcgeevamcgeeva member
    edited March 2018
    I’m sorry hopefully you won’t need a second round so you can put that awful cost behind you.

    Married: 5/09 ~ TTC Since: 10/10 ~ PCOS ~ Progesterone from 10/10 - 2/11 ~ HSG on 3/18 - Clear ~ Started Metformin 1000mg & Clomid 50mg 2/11 ~ Metformin upped to 1500mg 4/6 ~ 6/7 Now going to SG and put on Clomid, Ovidrel, Gonal F, Prometrium, Estrace ~ IUI #1 7/2 = BFP!!!!!! March 6th our little man was born. 

    6/17/13 - Ovidrel, Follistim, Prometrium ~ IUI #1 7/2 = BFP! March 17th our St. Pattys day baby arrived

    10/29/17 - Started process for IVF, got pregnant & miscarried a 2nd time since summer. 2/22 started stims - Menopur, Gonal F, Cetrotide - retrieval 3/6 - , PIO, estrace 3xday - FET 4/18 = Beta 1: 616; Beta 2: 1342 = BFP 

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