GHI/Medco - Need Help Please $$

Hi Ladies,

I'm completely clueless and feeling a bit stressed. This is my first medicated cycle. I just went to Dr. B this morning and got my list of meds and they told me I'd be getting them through Kraupner's. I spoke to Kraupner's and they told me I had to use Freedom because of my insurance (GHI and Medco). I needed three of the medications today, so they had to forward them to a local pharmacy and I ended up paying $200 for Femara. I know I totally messed this up, but I need to figure this out for next cycle so the same thing doesn't happen. I know next cycle I'll definitely order the medication earlier, but is it typically covered? Is it usually $200? Should I be using Freedom?

Are these meds covered through GHI or Medco? Do we have decent insurance for fertility medication? I just feel stressed out about how much everything will cost if this takes us months or longer.

Please impart any knowledge you have about this stuff. It would mean the world to me!

Thanks!

Re: GHI/Medco - Need Help Please $$

My insurance (Empire BCBS) requires me to use Freedom for fertility meds. I can get my Clomid at my local pharmacy, but the Ovidrel has to go through Freedom. My RE uses Kraupners so I just told them we had to use Freedom and they set it up.

Call your insurance company and see if your meds are covered. They probably are, provided you go through Freedom. Freedom has been great to deal with. The REs office places the order and then Freedom calls me to get the payment info and setup delivery. You can get it as early as next day.

Good luck!

Re: GHI/Medco - Need Help Please $$

Are you a NYC Teacher? I have GHI and use Medco and everything is covered and I use Kraupners!

Re: GHI/Medco - Need Help Please $$

Re: GHI/Medco - Need Help Please $$

Definitely call your insurance company today. Find out if they can reimburse you the difference if you over paid. This happened to me (different insurance company) when I went to the local pharmacy for ovidrel and paid $108 when my insurance would have paid for it through a specialty pharmacy. They sent me a check for the difference.

Re: GHI/Medco - Need Help Please $$

Re: GHI/Medco - Need Help Please $$

I have the same coverage as you and went through Freedom. Some of the meds are covered by Medco and the others through GHI's PICA program. Call GHI and let them set up your PICA account. When you speak to Freedom they should know what insurance to use for what medications.

Re: GHI/Medco - Need Help Please $$

Thank you so much! I so appreciate it - I feel like this is the only place I can get accurate information.

I called Medco and they told my they don't cover fertility medication. I also called Express Scripts through GHI and they said they don't cover it either. I also spoke to GHI and they said they don't cover it either. I know this is not accurate, but by the time I was finished I was ready to lose it.

I called Freedom again to check the status of the Ovidrel and progesterone suppositories and to check if they were being covered and by which insurance. The progesterone was fine and was covered by Medco. They said the Ovidrel would be covered through PICA. My only question is, I was told that I am only entitled to two cycles of injectibles. Would the single shot of ovidrel count as a cycle's worth of injectibles or is this different? I would hate to waste it because I might need to get much more aggressive than I am now.

Thanks so much!!