Village Fertility Pharmacy’s goal is to assist you in obtaining the maximum level of insurance coverage for your patient’s fertility medications. Insurance coverage for infertility medications can range from comprehensive to non-existent. Additionally, each insurance company has their own policies regarding fertility coverage and policies from the same insurance company may differ by each employer.

Ask our Insurance Specialist at insurance@villagepharmacy.com about our Insurance Pre-Verification Program. Prior to beginning any treatment, we recommend that your patients verify both their medical and pharmacy benefits for infertility so they are aware of the medication costs that may be associated with their treatments.

Your patients should call the "Member Services" number printed on their insurance cards to obtain detailed information regarding coverage, eligibility, prior authorization requirements and in-network pharmacies. Please refer your patients to the "Insurance" tab under the patients' section of this Web site for further information and sample questions to ask their insurance company.

Fertility medications are sometimes covered under a patient’s “medical” benefit instead of the traditional "pharmacy” benefit. In these cases, patients may be required to pay for their medications out-of-pocket and submit receipts to their insurance company for reimbursement. It is important to note that the patient may not be reimbursed the total out-of-pocket expense due to various factors such as deductibles, co-insurance, copay amounts, lifetime maximum limits and/or caps.

Some insurance companies require “prior authorization” for fertility medications. The insurance company may require clinical information from the health care provider before granting permission and payment for fertility medications. Please be advised that many insurance companies require 48 hours to review prior authorization requests. Copay amounts are dictated by the insurance company and are the same regardless of which in-network pharmacy provider your patient chooses to use.

In an effort to reduce waste/unused medication, some insurance companies have instituted Waste Management Programs. The intent of these Waste Management Programs is to limit the potential for unused medication during and after a patient’s cycle. These insurance companies require their designated specialty pharmacies to collaborate with patients and help manage the number of medication refills needed to complete a patient's cycle. Therefore, your patient may receive less medication than the actual amount written and her needs will be fulfilled through refills. We will work diligently to ensure that your patients have the amount of medication they need, when they need it.

Village Fertility Pharmacy participates in the DesignRx Managed Cash and the Ferring Heart Program for your patients who have no insurance coverage or have exceeded their lifetime cap/maximum dollar amount. These networks are designed to significantly reduce the cost of fertility medications for self-pay patients. Our Customer Care Representatives may be contacted at (877) 334-1610 to discuss pricing options.

Terms:
Annual Cap: This represents the maximum costs the policy will cover per year for a specific condition. If exceeded, a patient's insurance may no longer pay for any costs associated with continued treatment of this condition.

Co-insurance: The portion of eligible expenses that plan members are responsible for paying, most often after the deductible is met. Co-insurance is usually determined as a percentage of the provider's actual charge, or the allowed amount.

Copayment: A fixed dollar amount paid for a covered service.

Deductible: The dollar amount that a member must pay for health care services before a health plan will cover eligible services. For example, if a member's deductible is $500, the member will pay that amount out-of-pocket before the health plan will cover any eligible services.

Formulary: A pre-approved list of commonly prescribed prescription drugs. Most health insurance companies maintain some kind of formulary. Formularies are usually developed by a committee of physicians and pharmacists, and include both brand-name and generic medications. Medications included in a formulary are usually covered by a health insurance plan's benefits.

Prior Authorization: The process of obtaining prior approval for a medication from the health plan before the pharmacy may dispense that medication.

Lifetime Cap/Maximum Dollar Amount: This represents the maximum costs the policy will cover during your patient's lifetime for a specific condition. If exceeded, your patient's insurance may no longer pay for any costs associated with continued treatment of this condition.