IVF Medication Costs and IVFMeds.com

Anyone going through the IVF process knows that medication pricing is a super aggravating, time consuming process. Every pharmacy has different pricing and everyone you "know" who has done IVF purchased their meds from somewhere different. To find the best price, you need to make a whole lot of phone calls.

I began my search with my IVF clinic - who do they recommend, where do they usually send people. They, predictably, recommend the pharmacy across the street from them. They have a good relationship with them and they always have the meds they prescribe in stock. They're pricing wasn't bad but it certainly wasn't the best.

The next stop was google -I read through pages and pages from different forums cataloging the experiences of other women. From that, I picked out a handful of other pharmacies to check out, in addition to my standby pharmacy, Kaiser. They all had different prices and not all of them stock all my meds so it was pretty obvious I'd have to order from multiple places to get everything I needed.

As of this week, this is the pricing I got:

	Walgreens	Roxbury	Walmart	Kaiser	IVFmeds.com	Alexander	Freedom
Menopur per vial	75.5	76.95	140.17	57.19	38.5	74	78.9
Cetrotide 0.25	175.05	104.95	224.24	142	69	159	99.5
Omnitrope	335.89	377	378.44	357.48 (3)	N/A	N/A	N/A
Novarel	87.95	89.95	282.54	281.06	N/A	90	89.9
Dexamethasone (30)	N/A	20	14.32	Ins? 18.73	N.A	7	N/A

Surprisingly, Kaiser still beats out the usual US pharmacies for Menopur. I'm shaky on the Omnitrope because  I'm not sure if I've been asking for quotes on the right stuff - I was asking for a 5.8ml multi dose vial from other places, and Kaiser is the only pharmacy that actually received the prescription which states that I need three of "some dosage" of Omnitrope.  They're way off on the HCG though so I'll have to order that from somewhere else, and none of the Stateside pharmacies can hold a candle to IVFmeds.com in the UK for Menopur and Cetrotide.

I went back and forth a couple million times about IVFmeds.com. My nurse said they used to order from them all the time, but had to stop recommending them because the practice decided it didn't want to recommend pharmacies outside the US. They never had any problems with them and the nurse said she'd be happy to write me a RX to send over to them if I wanted. The thought of ordering medication, especially such important and expensive medication, from another country is nerve wracking. I'm already spending so much on the IVF, do I really want to cheap out on the drugs necessary to make it work? Is it safe? The savings ended up adding up to at least $3,000 over the two cycles so with the nurse's blessing I went ahead and placed the order. I'm still nervous but thus far their customer service has been great and the first box of my meds is already on the way.

Thus far, I've ordered:

IVFmeds.com

• 72 Menopur
• 4 Cetrotide 0.25

Kaiser

• Needles and syringes 
• 3 Omnitrope ?
• 30 Dextamethasone 1mg

The Novarel I'm going to have to order from either Walgreens specialty or Roxbury which is across the street from the clinic since Kaiser charges so much. I'm also going to try and get insurance to cover my Dextamethasone so I'll run that through Kaiser first and see what they say. Maybe we'll get lucky.

Decision Made!

After going back and forth a million times, doubting pretty much every aspect of our decision making process, making up our minds and then doubting things again, we've finally made our decision. I'm still not sure this is the right move and I feel a little sick to my stomach over the money we're about to spend, but this is it. Without further ado, we have decided to pursue IVF with....

Southern California Reproductive Center

Ultimately, I think SCRC and HRC would both be excellent centers. A part of our decision ended up being that I can't seem to get the billing department at HRC to call me back to discuss our Kaiser PGD coverage. I really liked Dr. Kolb and I think he would have been a good doctor. However, our PGD coverage will save us about $8,000 and I can't work with a center that won't accommodate that.  They said they'd be willing to work with me, no problem, but then never called me back. That doesn't seem to be a good start to such an important relationship and it played a part in us ultimately choosing SCRC. Dr. Danzer called me after our consult to see if I had questions and has replied to every attempt I've made to talk with him. He's definitely got the personal touch down.

SCRC is also a lot closer to our home than HRC. It will only take us 10 minutes to get to appointments and the staff has been much better about getting back to me. They have an excellent success rate with PGD and are considered a top center here in LA. We're proceeding with the same plan we would have gone with at either center and I officially started the suppression phase this morning. 

Going forward, we're proceeding with:

- The first freeze all IVF cycle with biopsy samples sent to Reprogenetics

- A second freeze all IVF cycle with biopsy samples sent to Reprogenetics

- PGD at Reprogenetics on all embryos 

- A FET with either one or two embryos

I'm hoping against hope that we get lots of wonderful, healthy embryos and that our first FET is successful. In the meantime, there's still a ton of stuff for me to do:

• Apply for Compassionate Care program and First Steps to get financial help.  We were approved for the minimum amount, 5% and 10%, but I'll take whatever we can get.
• Follow up with Reprogenetics. The billing manager needs a letter of agreement from Kaiser but the Kaiser lady has been on Jury Duty and then the billing manager went on vacation Friday to Monday. On Tuesday, both should be back in the office and I should get my letter. 
• I need to order a very large amount of sperm. SCRC wants two vials, Reprogenetics wants two vials, and I'm thinking we should have another two on ice to ensure our donor remains available to us. That's 6 vials for roughly $5,000.
• Meet with the financial adviser at SCRC to officially sign the paperwork and pay the nonrefundable $18,230.00 fee for our two cycles. As the cycles progress, we will pay separately for medication, ICSI (which is required for PGD), PGD biopsy (which includes assisted hatching) and our FET. 
• Submit the paperwork to Reprogenetics. I've been waiting on the letter of approval so I know what my portion will be. I think we're going to pay for the additional chromosome testing.
• Send DNA samples from myself, my mother and my sister to Reprogenetics for the creation of our probe.
• Pay to have two vials of sperm shipped to Reprogenetics for the creation of our probe.
• Pick up and bring two vials to SCRC and pay the $500 storage fee to have them stored there. 
• Pick up and pay for my first round of medication. 

This is such a huge decision. After a lot of discussion we've decided to accept some of the offered financial support from our families. It makes me a bit uncomfortable but if it's what is necessary to have children, it's just something we're going to have to get comfortable with. 

Can you tell how nervous/anxious/ahhh I am? It's like a miniature tornado churning in my insides. I'm not actually worried about the process itself, I'm a pro at injecting myself and the retrieval is just another procedure for me, but I'm terrified that this might not work. I'm terrified we're going to spend $40,000 and not have any viable embryos to show for it. I'm terrified that E will get completely discouraged and we will be done. I'm terrified that maybe he's not ready after all, that he's feeling just some of what I'm feeling, even though we're in this together and he says he's okay. I'm terrified of failing and never having children.

The only thing I can do is cross everything I have, rub every lucky rabbit foot and Buddha belly I come across, project every good vibe/thought/energy I can muster out into the world and hope with everything I've got that my body cooperates and we are able to create healthy, viable, life.

E2 Labs and Ultrasound

I had my ultrasound and labs this morning and the results were mixed. The good news is that we saw at least two little follies growing, one about 12mm and the other around 11mm! Two potential chances, I'm over the moon. There was also another follie that looked a little bigger but it wasn't quite right, the opacity was somewhat off or weird, so we're not holding our breath for that one. Two is still awesome even if its not the 4-6 we would have liked.

The not so great news is that my estrogen is still low. It was only 68 on Stim day 5 so I'm upping my dose of Menopur to the even more impressive, dun dun dun! 5 vials per day. We didn't start off on the max dose so we could move up if needed and that's what we're doing. Unfortunately, the initial egg recruitment is already done so we aren't likely to get more follies than those already there. She did see 4 more smaller follies on one side, but it's unlikely they'll grow big enough to ovulate for our IUI. The med increase also means we probably won't have any left over for IVF if this doesn't work. Fingers crossed it works!

5 Vials of Menopur is $287.60 per day. Ouch.

E and I also went ahead and ordered our vial of premium IUI quality sperm! I'm pretty excited to actually have a chance at getting pregnant this month since it will be our first opportunity to really have a shot. We pick up our swimmers on Tuesday in preparation for our IUI on tentatively Wednesday or Thursday if everything goes okay.

The next ultrasound is Monday so I'll have three days of 5 vials per day under my belt by then.  Please send all good vibes, thoughts, energy, etc to my little follies. In the meantime I'm going to acupuncture today and will ask her to do everything she can to get my lining thicker, my estrogen up and my follies healthy. I need those babies to grow!

$2,000 down and 4th Injection Done

Since it's become apparent that the insurance company has no intention of honoring their original medication coverage, I bit the bullet today and paid for my meds out of pocket. It was painful.

My first stop was Kaiser. I got the Menopur there for $57.52 per vial which is an excellent price as far as I can tell. I should have also purchased my Endometrin there, but there was a minor miscommunication with the other pharmacy I was purchasing from. They quoted me a cheaper price than Kaiser, but neglected to mention that my RE had ordered two boxes of Endometrin, not one.

When I checked out, the pharmacist said he'd never rung up a bill so high in the 6 years he'd been working there. He'd never seen anyone pay 100% OOP for fertility drugs, the most he'd encountered was 50% and he was astounded that we had literally no coverage for the meds. He actually wasn't sure the system could ring up a bill that high and it did decline my card the first time I swiped it. The second time it worked, with extra authorization, and I left with my $1725.80 worth of Menopur.

The next stop was Northridge Plaza pharmacy, which had my Orvidel for around $77, which was great, but my Endometrin was over $200 for two boxes. I ended up checking out at around $295 and here my card was declined again. I ended up having to call my credit card and assure them it wasn't fraud before they would allow me to make the purchase. They promised it wouldn't happen again and I let them know I'd be making another $800 purchase in the next few days.

While I was waiting on the phone, a woman came up to purchase her trigger shot. She's doing her IUI on Saturday and was thanking the pharmacist for running her Menopur through her insurance. Apparently her Menopur was only $30 and she was so happy she almost cried. I wished her luck, looked down at my $1725.80 worth of Menopur (I was afraid to leave it in the car) and hoped/wished/crossed everything I had that this cycle yields a healthy baby.

On the way home from Northridge, the wood inset on my driver's door handle literally fell off on my foot. It felt like the universe was just rubbing salt in my wounds. I know my car is over 10 years old but I can't pay for insanely expensive fertility medication and a new car at the same time, so she's just going to need to hold herself together. I super-glued the panel back on with some Gorilla glue and I hope nothing else decides to fall off my car in the meantime.

Finally, today was CD4 and injection number 4. It burned like last night but I didn't have any problems with bubbles so the entire process went a lot faster. My routine takes about 15 minutes, I turn on my music, sterilize everything, mix up the injection, put it away, go pee, sterilize everything again and give myself the injection super, super slowly. I could probably shorten the process but it seems to be working for me and there are a lot of vials to sterilize :/

Tomorrow is my next ultrasound, please let there be lots of little follies growing in there!

Injections Day 3 and OOP Expenses

After crossing everything I have and holding my breath and arguing and hoping that my insurance would come through and pay for my meds, they have predictably decided not to cover them.

E and I were not expecting to be shelling out this much for a week's worth of medications, but since we have no other options, I called a every promising pharmacy I could find and comparison shopped. I think I've got the best prices I'm going to find between two different pharmacies so I'm heading over tomorrow to pick everything up. I still need to get 30 vials of Menopur, one Ovidril injection and 30 Endometrin capsules.

Today was also day three of my Menopur injections and this one was probably the most physically uncomfortable. There was a bubble that was a huge pain in the ass to get out and then the liquid burned like hell going in. It's still uncomfortable now and I'm starting to think my left side might be more sensitive than my right. Bleh.

Positive thoughts. I'm thinking positive thoughts.

Insurance Run Around and the Second Injection

Today I woke up a little sore. I was expecting most of the uncomfortable feeling from last night's injection to fade but it has stayed with me pretty much all day. It's not awful, just noticeable when I move around or bend over,  like some kind of tender heaviness in my stomach.

I spent pretty much all morning on the phone with insurance companies (aka on hold). My first call was to Kaiser, who reiterated that I should have coverage but oh wait, apparently I don't. The service operator at the Kaiser payment assistant center is also undergoing fertility treatments so she was sympathetic when I asked about discounts for cash customers, but she couldn't help. Her supervisor suggested I call Medi-Cal, which was just laughable.

Next I called our health plan provider, who said we have a separate prescription plan independent from Kaiser. This is news to me, considering that we've been getting all our prescriptions at Kaiser without issue until now, but okay. I rang them, they said hmm I don't think it's covered but it's on the list for injections so they transferred me to a different company that handles injections.  They said sorry, we don't cover infertility meds and transferred me to Freedom Fertility. We still have no idea if we have any kind of insurance for our prescriptions but my RE faxed over my scripts and we should have an answer tomorrow. Either way, I'm running out of donated meds so we'll have to get some in hand soon. Please keep your fingers crossed.

(Batiuk)

After my gym class today, I took my second Menopur injection. It was much less eventful than the first since I think I got out most of my internal despair yesterday. I didn't burst into tears at the sight of the syringe and I was able to psych myself up for it fairly quickly with some good music and a few deep breaths. This shot also burned a bit less so I'm hoping the injection site is less sore tomorrow morning when I have my next gym class. It still hurt to bend over and squish my tummy, but again it's really not that bad. 

My goals for the rest of the week are to sort out the prescription debacle and stay positive. We still have a 50% chance for a healthy baby if this works and stress will not do me any favors.

IUI: The Disasterous Beginning

So after years of trying, we're finally starting a process that just might work. Today I went in for my baseline ultrasound that gives the RE a starting point for my IUI. This was the hopefully beginning of the post that I wrote this morning before I went to my appointment. It's not the opening I would have chosen afterwards. That would probably go more like:

I went to my first IUI appointment today. The ultrasound went great but the latter half the day was a complete and utter disaster.

I got to the hospital on time, with the 15 minutes to check in I always seem to miss, and after circling a couple times I lucked into the best parking spot. 2 hours of free parking? Yes please! I thought this was a sign our IUI was off to a great start and gave myself a mental fist bump. 

I met a new OB/Gyn and some really sweet nurses who were great company while they checked me in. I couldn't pee right away for the pregnancy test we all knew would be negative, even though I'd guzzled water, so the nurse let me proceed and said I could pee later. The ultrasound itself was a little uncomfy (as if a wand going up your girly bits could ever be anything but uncomfortable) and I had 9 antral follicles! That is AMAZING for me,  I've never had more than 7 follies. I would have danced on the table but the OB still had the wand so I settled for telling her how pleased I was with my body and how acupuncture seems to be working. 2 extra antral follies after only 3 acupuncture sessions and a week and change of herbs? I'm sold.

(I love your comics Phoebe Potts)

The nurses have the routine down, so after my ultrasound I went over my treatment with the OB and discussed the massive amount of meds I'm going to be taking. She was nice, was familiar with my file and we joked about the insane prices of donor sperm. There is always a long line at the pharmacy, so the nurse had me go down and put in my prescriptions before getting my injection training. I went back up, watched the nurse mix pretend Menopur, she told me how easy it would be to inject myself and then sent me on my way to go pick up my meds. I still hadn't peed yet.

As predicted, that pharmacy line was LONG. It took me about 30 minutes to get through, standing behind a high school student hiding a pregnancy test against her leg and hoping no one would notice. I felt badly for her and hope she got the negative she wanted, she was clearly terrified and wishing to be anywhere else.  It's nice to know I'm not so dead inside that I would resent the fertility of a scared teenager, though I did resent the lazy father telling his 2 year old he was going to tie her up (stroller) if she didn't sit still and be quiet. She's 2 asshole. 2 year olds aren't designed to sit still and be quiet, with no entertainment, for 30 minutes.

Finally I get to the front of the line and the pharmacy assistant starts pulling out box after box of drugs. There's a crap ton of menopur, my ovidrel trigger shot, progesterone, needles, and syringes. She starts ringing them up:

Her: Wow, this is over 1000 just for this? 
Me: Yeah, fertility treatments are expensive :/
Her: This is expensive, over 2000!
Me: You mean before insurance? Cause we should have 100% coverage
Her: Uh, no...you pay 100% All of it. $2000 please.

SCREEEEEEEEEEEEEEEEEEEECCCCCHHHHHHHHH

We are NOT supposed to pay 100% out of pocket! The whole reason we switched around insurances and paid a fortune to the union was so we would have infertility coverage! It's been confirmed numerous times by different people and now they're telling me to fork over $2,000 for a weeks worth of meds?????? I explain all this to the assistant, she enlists another assistant and freaking out, I head back upstairs to go pee in my cup and panic. 

I explained the whole thing to my nurse, and then to my doctor, who also insisted we should have coverage. When my nurse called for help, the pharmacy services insisted we had no coverage and hung up on her! I couldn't believe it and I kept trying to get ahold of E to ask if I should go back down and spend $2000 on the meds since we can't not have them. While I was doing that, the nurses were angels and scoured the office looking for donated Menopur for me. I was so thankful I almost cried, they found 4 boxes, which is 5 days for me, and told me to call back in the morning to see if we can fix things. If not, my doctor said she'd put in a prescription at a cheaper pharmacy for me and we'd just have to pay out of pocket. The nurses kept saying they hoped the donation would pay off with a baby, and I didn't have the heart to remind them there's a 50% chance I might have to terminate if it works. I almost cried again.

With donated Menopur in hand, I went back to the pharmacy and paid for my needles and syringes. They were really apologetic but I had to leave without the rest of my meds. I drove home somewhat shell shocked, where I met my mother who wanted to talk to me about my premutation. Apparently, although it's insanely rare, my premutation was passed down by my father, not my mother. She wanted to talk, discuss options, make me an appointment at UCLA and offer us money we're not sure we're comfortable taking. I wanted to scream that I've been over the options and back over them a million times, but it's not something we feel comfortable discussing with her. My defenses were low and I explained more than I wanted to, when I really just wanted to go cry in a corner.

Why are you so expensive???

I really hope we can get this prescription problem sorted out. I need enough Menopur to stimulate a large horse and it will be insanely expensive out of pocket.