Financial Reassurance For Patients Affected by COVID-19

We understand that some patients may choose to delay or cancel their IVF cycles in the midst of the coronavirus (COVID-19) outbreak. In an effort to alleviate the financial pressures that accompany this decision, MDR has partnered with Reunite Rx to offer “ReUnite Reassurance”. If a patient is forced to cancel her cycle due to quarantine for COVID-19, any Follistim AQ, Ganirelix Acetate, and Pregnyl that have been used will be replaced at no additional cost.

PROGRAM REQUIREMENTS:

• Cycle cancellation due to quarantine for COVID-19 before September 30, 2020*
• Patient was taking Follistim AQ during the canceled IVF cycle
• ReUnite Reassurance Program Form confirming reason for cycle cancellation
• Medications were filled at MDR Fertility Pharmacy
• Self-pay patient (no fertility drug benefit)

*Patient application must be received the day of cycle cancellation.

ELIGIBLE MEDICATIONS:

• Follistim AQ Cartridge (limit: 2,700 IU)
• Ganirelix Acetate Merck Brand (limit: 5 syringes)
• Pregnyl (limit: 10,000 IU vial)

APPLICATION INSTRUCTIONS:

1. Download the ReUnite Reassurance Program Form.

2. Ask your physician to complete and sign the form.

3. Send an email to [email protected] with the following documents:

• ReUnite Reassurance Program Form

• Medical records confirming canceled IVF cycle due to quarantine for COVID-19

For questions about the ReUnite Reassurance Program, contact ReUnite Rx at 844-385-5403.

ReUnite Reassurance Program Form

Download the ReUnite Reassurance Program Form to confirm the reason for cycle cancellation.

Terms and Conditions

Medical records are required from the fertility clinic indicating that the IVF cycle was canceled during controlled ovarian hyperstimulation due to quarantine for COVID-19. Documentation that the patient was taking Follistim AQ during the canceled IVF cycle is required. Patients not taking Follistim are ineligible for the ReUnite Reassurance Program. Medications will be replaced based on the quantity used up until the cancellation date. Medications eligible for replacement are the following Merck & Co. products: Follistim AQ, Ganirelix Acetate, and Pregnyl. Medical records and application will need to be reviewed and approved by ReUnite Rx. ReUnite Reassurance will be available to patients whose IVF cycles were canceled due to quarantine for COVID-19. ReUnite Rx reserves the rights in its sole discretion to approve, deny, or cancel ReUnite Reassurance program applications.