fertility prescription coverage for doe employees

hi, I am new to this site. I work for the doe and have ghi. I was recently told that I was no longer covered for progesterone in oil cause I maxed out my benefits. a friend of mine ( also works for doe) never had this issue and ordered this need hundreds of times. the Dr office and pharmacy also said this is never put in the category if ivf meds and usually covered.  any of you work for the doe and been covered more than 3x for this drug?

Re: fertility prescription coverage for doe employees

I used to work for the DOE and also had that 3x lifetime max. It's not that it's a fertility drug, it's that it's an injectable. Any injectable drug can only be prescribed 3x.

The only thing I can think of is possibly it's different if it's to maintain a pregnancy... like maybe it goes under a different code? .. I really don't remember because we ultimately switched to my DH's insurance. I'd call and ask if it makes a difference once you are pregnant- but otherwise yes I had that 3x limit too with ghi.

Message edited 5/24/2013 1:40:37 PM.

Re: fertility prescription coverage for doe employees

i maxed out mine too and did not know they had a max and ended up paying so much for all our meds

sorry