Insurance coverage for fertility medications can be complex, as they are considered “specialty” medications. Your level of coverage (if any) will depend upon a variety of factors, including the state you live in and your specific health plan. MDR has been helping our patients navigate insurance coverage for over 30 years. Our team of experts is skilled at providing comprehensive insurance verification and screening to maximize coverage and minimize out-of-pockets for our patients . We will help verify coverage levels, co-pays, and prior authorization requirements so you have a clear understanding of the costs you’ll be responsible for.
Frequently Asked Questions
Which insurance plans are accepted by MDR?
MDR accepts most nationwide health plans. However, coverage for fertility medications will depend on your specific plan design. Please contact MDR and one of our insurance specialists will help you navigate your coverage.
How can I find out if I have fertility coverage?
You can contact your health plan directly or review your plan’s policy booklet. MDR also offers free insurance screening, which includes navigating coverage levels, co-pays, and prior authorization requirements. If we find you have coverage, we will direct bill your health plan. No need to submit documentation for reimbursement.
I have insurance, but no coverage for fertility treatments. What are my options?
We have had success in finding coverage for patients who thought they had none. However, if we find you have no coverage, you still have options. MDR is a preferred network provider in the ReUnite Rx Managed Cash Program and Ferring Heart Program. These programs offer a substantial reduction in out-of-pocket costs for patients who have no fertility drug coverage. As a result, MDR’s pricing on fertility medications is generally much lower than the pricing at a local/retail pharmacy. In addition, you may qualify for up to 75% off the cost of select medications based on your income level or military service . Click Here to learn more about the savings programs available to you.
How can I find out what is my co-pay amount?
Our insurance specialists will thoroughly investigate your insurance coverage to find out the exact co-pay for your medications. Keep in mind that co-pays vary depending on numerous factors.
What is prior authorization?
A prior authorization (PA) is an extra step used by some health plans to determine whether they will cover a specific medication. Our insurance experts will work directly with your clinic to submit all required documentation in a timely plan. Based on the documentation submitted, your health will decide whether they will cover the cost of the medication.