Access To Free Medication For Fertility Preservation

Each year more than 150,000 Americans of reproductive age are diagnosed with cancer. Chemotherapy and radiation, while highly effective against cancer, may cause irreversible damage to reproductive issues. Fortunately, fertility preservation options exist to give cancer survivors the chance to build a family in the future. However, these costs are generally not covered by insurance providers. First Steps for Fertility Preservation was created to reduce this financial burden by offering select fertility medications at no cost to eligible patients based on income.

ELIGIBILITY REQUIREMENTS:

• US Citizen or Permanent Resident
• Female with a cancer diagnosis, but have not started treatment
• Self-pay for your medications
• Signed Oncologist and Reproductive Endocrinologist certification forms
• Current W-2 form

ELIGIBLE MEDICATIONS:

• Follistim AQ (2,700 IU Maximum)
• Ganirelix (5 Syringe Maximum)
• Pregnyl (1 vial Maximum)

ENROLLMENT INSTRUCTIONS:

1. Download the Oncologist and Reproductive Endocrinologist certification forms provided below.
2. Ask your Oncologist and Reproductive Endocrinologist to complete and sign the certification forms.
3. Click Enroll Online and upload your signed certification forms and your W-2. You will receive an email with the status of your application within 24-48 hours.
4. If your application is approved, fax your prescription to MDR at 1-888-939-2020.
5. Call MDR at 1-800-515-3784 and provide us with the ID numbers listed on your approval letter. We will ship the medication at no cost.

Download physician certification forms below.

Reproductive Endocrinologist Certification Form

Oncologist Certification Form