The cost of fertility drugs with insurance coverage is often higher than people expect. There are the obvious holes: copayments and limitations. But there are indirect costs as well: other procedures, side effects, and the pregnancies that result.
Most couples need to cover fertility drug costs without insurance. Only the lucky few have policies covering fertility medications. Either with or without health insurance coverage fertility medication costs need to be managed. Find ways to cope by following the outline and links.
- Average costs of fertility drugs
- Costs with insurance
- Methods for finding coverage
- Discount alternatives
Average Costs of Fertility Drugs
The average price of fertility drugs varies by the type of drug your doctor prescribes. Your direct costs depend upon whether your insurance picks up the tab, the price you must pay, discounts you can find, the dosage levels prescribed, and number of cycles needed to get pregnant.
Some medicines are used alone, others in combination, but most frequently they are taken in conjunction with a variety of Assisted Reproductive Techniques (ART) such as Artificial Insemination, Intrauterine Insemination (IUI), In Vitro Fertilization (IVF). Many times these are self pay items.
Explore strategies to keep more of your money while taking the medications, after getting pregnant, and while bonding at home with your newborn baby. Find costs for the most commonly prescribed fertility drugs such as:
Costs of Fertility Drugs with Insurance
Costs of fertility drugs with insurance are always the lowest for the person taking the medication. When it comes to paying for prescription fertility drugs the best scenario is to pay with other people’s money: your health insurance company. There is no greater discount than a prescription drug card with a formulary listing one or more of your prescribed medications on the list.
If your plan provides this coverage keep in mind any deductibles you must pay. Sometimes there are both individual and family deductibles that must be met before benefits begin. If a couple is taking medications for both the man and the woman you may face the individual deductible twice.
Prescription Drug Formulary
Most prescription drug plans have a three tier co pay structure: generics, preferred, and non-preferred (or name brand). The co pay is smallest for generics, and highest for name brands. Some express the co pay in terms of hard amounts: $20, $30, $50, etc. These designs work best for cost containment. Plans often come with percentage based co pays which may cost patients far more. A fifty percent co pay on a medical therapy combination costing thousands helps, but still leaves a gaping hole.
The most common scenario is that your insurance plan pays nothing. Most plans choose not to cover any infertility treatments unless required by state law. Fifteen different states have an infertility mandate. Knowledge of the laws may assist you in finding coverage.
Calculating Total Costs of Fertility Drugs
When asking how much do fertility drugs cost, make sure you consider all of the direct costs associated with your ART protocol. You may start with a low price drug such as Clomid, and graduate on to pricier alternatives that may require bigger doses, multiple cycles, or may be combined with other ART procedures. You just don’t know when your infertility journey will end, so finding ways to cut spending helps preserve assets.
Prices, Dosage, and Number of Cycles
The price you pay of course depends upon what medication(s) your endocrinologist prescribes. Prices range from a few dollars to thousands of dollars per dose or injection. You may take a single dose or multiple doses for weeks or months. Buying larger quantities may yield better discounts, but if you get pregnant before using every dose, you may have overpaid.
Buying any fertility drug without a prescription is not advised and is a terrible way to save money. Couples often have leftover cycles once they conceive, and put up for sale signs online. Avoid this route at all costs. Not only is the drug quality suspect, but you may lose tax deduction discounts, and/or suffer serious side effects.
You can buy medications online through pharmacies in Canada and other foreign countries which may sometimes lower the prices you pay. Drug quality is difficult to measure, and you may introduce indirect costs if quality is substandard. Again this is not advised.
You can buy medications over the counter. A variety of herbal remedies, vitamins, and supplements that promote overall wellness have been associated with increased chances of getting pregnant. These items often come with far lower prices, but equally lower odds of helping you conceive.
Side Effects are Indirect Costs
Fertility drugs have been associated with a variety of outcomes. The primary outcome is very positive: women get pregnant and deliver a healthy baby! Sometimes these medications are linked with multiple pregnancies: twins, triplets, quads! Other outcomes are less joyful: side effects, and birth defects. Each outcome increases indirect spending.
Positive Side Effect is Pregnancy
Fertility drugs and getting pregnant is a happy outcome that may increase your medical expenses, while reducing mom’s income. Many women take an unpaid maternity leave, which may create hardship after spending so much money just trying to get pregnant. Supplemental health insurance for infertility can replace mom’s income, and pay benefits that offset many of these expenses.
The most common side effect of many fertility drugs is multiple pregnancies. Many follicle stimulating hormones promote extra egg production. More than one quality egg increases the chances that two or more eggs become fertilized. Multiple pregnancies are often high risk, and deliver preterm. Mom may experience added expenses for hospitalizations, and additional lost income during an extended pregnancy leave. Preemies confined to an NICU leave many couples with unpaid medical bills.
Negative Side Effects
Fertility drugs have been associated with a variety of side effects: cancer, vision loss, ovarian hyperstimulation syndrome (OHSS), and kidney failure. Studies are inconclusive and often contradictory on whether these medications increase risks for any of these conditions. However, if you experience one or more of these conditions you may experience increased medical expenses, combined with lost income. Is this beginning to sound familiar? Guess what, supplemental maternity insurance covers these side effects as well – regardless of origin.
Some studies have linked fertility drugs with an increased risk of birth defects. If your infant is found to have a birth defect there may be additional unreimbursed medical expenses for testing, monitoring, etc. There may also be lost income if one or both parents need to stop working to provide care at home. Unfortunately, supplemental insurance will only cover your infant for the first 30 days after live birth.
Fertility Drug Discounts
Fertility drug discounts are available using tax deductible medical expenses, and pharmacy discount cards. Your unreimbursed medical expenses: deductibles, co pays, coinsurance, and amounts you must self pay are all tax deductible infertility expenses. There are two ways to get your IRS discounts: Flexible Spending Accounts (FSA), and Schedule A which is filed every tax year.
Tax Savings Discounts
An FSA provides you with first dollar discounts on your fertility drug purchases up to a set limit each year. You can double the limit by participating in the plan offered by both spouses’ employers. You save federal, state, and FICA taxes when you use the pre tax dollars in an FSA. Many couples can realize a discount of up to 33% or more by using their FSA. Many plans now come with a debit card, making it very convenient to purchase prescription medication online.
Schedule A provides federal income tax savings on expenses that exceed 10.0% of Adjusted Gross Income. Usually this option works best for couples taking these medications as part of a more expensive ART procedure.
Pharmacy Discount Cards
Pharmacy discount cards are becoming more and more popular. They are not insurance plans, but provide couples with the opportunity to buy their medicine at wholesale prices, rather than retail. Often times the cards are offered free to consumers, or as part of an employee incentive program. We offer a free card to anyone brave enough to introduce us to their employer in order to take advantage of supplemental maternity insurance.