ReUnite Oncofertility

Cancer Patients Save on Select Medications

Cancer treatments can impact a woman’s fertility. Fortunately, fertility preservation options exist, but generally the costs are not covered by insurance. ReUnite Oncofertility helps to reduce the costs for fertility preservation by offering a discount of up to 100% on select medications. The discount a patient receives is determined by her level of financial need.

Eligible Medications

• Follistim AQ Cartridge (follitropin beta injection) – Limit of 2700 IU
• Ganirelix Acetate Injection (brand name) – Limit of 5 syringes
• Pregnyl (chorionic gonadotropin for injection, USP) – Limit of 1 vial

Eligibility Requirements

• Female patient requiring cancer treatments affecting her fertility
• No prior chemotherapy
• Cash-pay prescriptions (100% uninsured)
• Completed Oncologist Form
• Current proof of income (IRS 1040 tax form)

Application Instructions

1. Download the Oncologist Form and ask your oncologist to complete the form to certify your eligibility.

2. Apply online. You will be asked to upload the completed Oncologist Form and a current IRS 1040 tax form.

3. Submit your enrollment application. You will receive an email notification within 24-48 hours regarding your application status.

4. If approved, provide MDR with the Member ID number contained in the email and we will apply the discount to your prescription.

For more information about this program, call 1-800-515-3784 or email [email protected].

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