How To Battle The Rising Cost Of Infertility Treatments in NYC

battle-the-rising-cost-of-infertility-treatments-in-nyc

 

If you’re dealing with infertility in NYC, you know that the common question patients have is: “what will my insurance plan cover and how much will my out-of-pocket expense be?”

There are two sides of the coin to consider:

  • the clinical costs
  • and the medication costs

Patients are often surprised at the cost of the injectable medications used for fertility treatments such as in vitro fertilization (IVF). For many, insurance will help to significantly reduce the out-of-pocket costs. But when insurance isn’t an option, pharmaceutical companies offer their own financial programs to help patients. Understanding your options and working with your dedicated medical team can help you save.

TIP 1: UNDERSTAND HOW THE PROCESS WORKS

Informed patients can achieve the greatest cost savings when it comes to medications. Understanding the medications and the discounts and programs offered by their manufacturers can help make navigating the financial options easier.

Commonly-prescribed stimulation medications: Frequently, physicians prescribe follicle-stimulating hormone (FSH) medications to intrauterine insemination (IUI) patients (who are using injectable medications) or IVF patients during the follicular development phase of the cycle. These medications work to recruit, develop, and grow multiple follicles which contain an egg. For most patients, the stimulation medication makes up the bulk of their medication cost.

TIP 2: BE YOUR OWN ADVOCATE

Use your resources: When preparing to start a cycle, find out who will handle your prescriptions on your medical team—it will likely be either the clinical assistant or nurse. This member of your team will order your prescriptions and help you when it comes to making sure you are prescribed the most cost-efficient medications.

Call your insurance company: When planning to use insurance benefits to cover the cost of treatment, proactively speaking with your insurance provider to determine their preferred brands can help ensure your physician prescribes the most cost-effective medication.

Know your medical protocol: This step is especially helpful for patients planning to pay out-of-pocket for infertility treatments in NYC. Most mail-order pharmacies in NYC will contact the patient directly to provide a quote for the medication before filling the prescription. Knowing the type of medications prescribed and an idea of the cost can help address any potential issues prior to filling the medications, saving both time and money.

TIP 3: CONSIDER A PHARMACEUTICAL FINANCIAL PROGRAM FOR MEDICATION

At Kings, we offer several financial programs to help make infertility treatments in NYC more affordable.

  • Co-Pay Savings Card

Harvoni, Sovaldi, Viekira Pak, Daklinza, Endometrin & Gonal-f, Ovidrel, Cetrotide: Co-pay card available directly through Kings Pharmacy for qualifying patients with a valid prescription

    • Financial program designed for insured patients.
    • No approval process.
    • Savings card is valid for one year.
    • Save up to $250 off of Gonal-f, up to $25 off of Ovidrel, and up to $25 off of Cetrotide prescriptions.
  • Compassionate Care Program (Offered at Kings Pharmacy)

Kings Pharmacy participates in EMD Serono’s Compassionate Care Program, which is designed to provide eligible patients savings on Gonal-f, Ovidrel, or Cetrotide. Depending on certain criteria, eligible patients may save 25%, 50%, or 75% off the self-pay price of medicine or receive a $10 discount per unit, via a mail-in rebate, off their out-of-pocket costs.

    • Discounts on Cetrotide, Gonal-f, and Ovidrel.
    • Program offers a four-tier discount program (10%, 25%, 50%, or 75%) based on income and other factors.
    • 25% discount for all military active duty, veterans, and retired—no income verification required.
    • Shady Grove Fertility Shared Help Program participants are immediately eligible for a 50% discount off medications.
    • Submit registration and income verification documents or SGF Shared Help eligibility letter.
    • Upfront savings—approved participants will receive a discount card to present to the pharmacy.
    • Since January 2013, the average SGF patient in our Rockville office saved over $1,951 with the Compassionate Care Program.
  • Go Direct to Savings  (Provided by EMD Serono. Offered at Kings Pharmacy)

Kings Pharmacy has partnered with EMD Serono to offer the GO Direct To Savings Program, which can save nearly 10% on Gonal-f, Ovidrel, or Cetrotide on every cycle. The more medication needed throughout a patient’s treatment, the more he/she will save.

    • Discounts on Cetrotide, Gonal-f, and Ovidrel.
    • Gonal-f:$10.00 off per 75 IU.
    • Ovidrel: $10.00 off per 25 mg.
    • Cetrotide: $10.00 off per 0.25 mg.
    • Available for self-pay patients who are not eligible for the Compassionate Care Program.
    • No approval process.
  • HEART+ Program (Provided by Ferring Pharmaceuticals)

Kings Pharmacy participates in Ferring’s HEART+ Program, which offers eligible patients significant savings on prescriptions for Bravelle, Menopur, Endometrin, and Novarel.

  • Foundations

Patient Access Network Foundation, Patient Advocacy Foundation, HealthWell Foundation, Good Days & Financing (available for fertility medications ONLY)

Kings Pharmacy has partnered with Prosper Healthcare Lending, the premier financing company in the healthcare industry, to offer financing options for fertility patients. With over $3 Billion borrowed and over 250,000 people empowered, this is a name and a program you can trust. With a loan from Prosper Healthcare Lending, you can expect: immediate decisions for loans under $35,000, longer terms for lower monthly payments, no collateral required, no prepayment penalties, fast & easy loan inquiry process, and 100% confidentiality.

*Please note: In order to be eligible for assistance the patient must be a legal U.S. resident and meet certain financial, medical and insurance criteria as required by the respective assistance programs and/or co-pay card programs we work with to establish funding.

TIP 4: NYC FERTILITY PROGRAMS/COMMUNITIES

NYS Infertility Demonstration Program

    • A grant from New York State for in vitro fertilization (IVF) and gamete intra fallopian transfer (GIFT)
    • The NYS Infertility Demonstration Program provides financial support to privately insured individuals whose insurance coverage for IVF is exhausted or inadequate
    • Only residents of NYC between the ages of 21-44, be clinically infertile and other clinical and program criteria are granted financial support
    • Funds are allocated to select centers meeting high standards of IVF success rates and patient volume

 

  • The program also includes a subsidy for testicular sperm extraction (TESE)
  • Services will be paid by the NYS, through the providers, with the exception of any insurance reimbursement available, and a cost sharing amount that the patients will be required to pay.
  • This cost sharing amount varies by the patient’s household income and the cost of the procedures, but cannot exceed ten percent of the patient’s gross household income in any one year
  • Financial support is available on a sliding scale basis and extends to patients with household income up to $200,000.