Paying for fertility medication

Medication can be the part of a plan that catches people off guard. It is worth planning for on its own, apart from the clinic's estimate.

You do not have to figure it out alone or all at once. This guide gives you an order to work in, and a way to keep track of what you learn. It is about process, not about which medication is right for you. That question belongs to you and your doctor.

Ask your clinic first

Your clinic is a good first call. Before you contact anyone else, ask them:

• Who orders the medication, the clinic or a pharmacy? How does the order reach me?
• Which pharmacy do you usually work with, and can I use a different one?
• Does the clinic give me a written list of what I will need, and when?
• Do you know of any savings or support programs your patients use?
• What should I do if a prescription changes partway through?

Then ask your plan a related question: is medication covered under a separate pharmacy benefit, and does it require a specific pharmacy? Ask about the visits and the medication separately, so nothing gets assumed. Our Questions to ask tool has an Insurance or HR benefits list that includes this one.

If you are not sure how your plan works, RESOLVE's insurance coverage by state page includes questions about whether state law applies to your plan. Your benefits team can confirm what applies to you.

Manufacturer programs and their rules

Drug makers run savings and support programs, and each one has its own eligibility rules. Start with the program pages themselves:

• Fertility LifeLines from EMD Serono
• Ferring's support and savings programs
• Organon's access and savings page

Because each program is different, read the rules before you count on any help. Things to check on each page or to ask by phone:

• Who can apply, and what do I need to show?
• Which of my prescribed items does the program cover, and which does it not?
• Do I apply, or does my clinic or pharmacy?
• Can I use it together with my insurance, or with another program?
• Does it expire, and do I have to renew?

Your prescriber can tell you what has been prescribed for you, and the program can tell you whether it applies. Neither one can do the other's job.

Comparing pharmacy quotes in writing

If you have a choice of pharmacy, it can help to ask more than one for a quote. Make it easy to compare by asking each one the same things, and asking for the answers in writing.

• What is the full price for everything on my prescription list?
• What would I pay with my insurance, and what would I pay without it?
• Are shipping, storage or handling included?
• How long does an order take, and what happens if something is delayed?
• Is there a way to pay in parts, or to hold an order until I am ready?

Put the quotes side by side in one note. Write the date on each one, since a quote is only a snapshot. Ask your clinic to confirm that any pharmacy you choose can supply what your plan calls for.

Keeping receipts and records

Save everything, even when it feels like too much. A shoebox or a folder on your phone works.

• Receipts for every order, pickup and shipment
• Prescription lists and any changes your clinic made
• Program approvals, confirmation numbers and the dates they apply
• Insurance explanation letters and any denials
• A call log with the date, the name of the person and a reference number

Keep your running totals in the Cost and funding planner, so you can see what is covered, what is still left and what to ask about next. It runs in your browser, so what you type stays with you.

If you are looking for help beyond medication, the medication savings section of our directory lists these programs in one place.