rvH3Ah8zFtRX OP t1_je0miey wrote on March 28, 2023 at 3:42 PM

Reply to comment by np20412 in Should we consider dropping my employer-sponsored insurance to get coverage for a specific procedure? by rvH3Ah8zFtRX

Thanks. Honestly I get a bit confused about pharmacy coverage and how that gets intertwined with everything. My wife's plan through her job had a separate pharmacy administrator. My plan at my last company had a pharmacy-specific deductible, while my current plan does not. But maybe that's all irrelevant regarding IVF if infertility treatment isn't broadly covered regardless.

np20412 t1_je0onvh wrote on March 28, 2023 at 3:56 PM

The way our plan worked for Pharmacy portion was just that the meds were not covered by the normal pharmacy benefit at all, the claim was denied, but then the cost was picked up by the fertility/ART benefit. My plan offered $7500 worth of lifetime coverage for prescription drugs as part of IVF and we blew past it in the first cycle (total cost was around $9k for meds, so $1.5k out of pocket for us). You just will want to make sure the infertility benefit will cover the pharmacy portion, if the pharmacy part of the plan itself isn't offering coverage for fertility medication.