Sorting out fertility medication coverage can feel overwhelming, but you don't have to do it alone.
This page explains how pharmacy benefits work, why speciality pharmacies are important, medication savings programs you may qualify for, and other practical ways to lower out-of-pocket costs.
Many insurance plans cover procedures and prescriptions under different benefit "buckets."
Fertility medications (like stimulation injections, trigger shots, and progesterone) are often billed under pharmacy benefits with their own copays/coinsurance, tiers, and quantity limits.
Some insurance plans require prior authorization for certain drugs, and many specify a preferred specialty pharmacy. After your first consultation with an Illume physician, we’ll confirm your plan's preferred pharmacy and any other important coverage details.
Learn the biggest factors that change what you pay and simple ways to spot savings.
Some medicines are brand-only biologics with no generic option, while others have lower-cost equivalents your plan may cover.
Pen injector vs. vial, prefilled vs. multi-dose, and form affect price. Mismatched vial sizes can leave you paying for unused medicine.
Insurers sort medicines into tiers (generic, preferred or non-preferred brand, specialty). The amount you're responsible for will vary.
Many plans require a specific specialty pharmacy; their shipping, fill options, and negotiated rates can raise or lower what you pay.
Requirements like prior authorization, quantity limits, or "step therapy" can change which medicine you get and what it costs.
Many insurers (and fertility benefits providers) require that your prescriptions be filled through an in-network specialty pharmacy.
These pharmacies offer fertility-savvy support, cold-chain shipping (to keep medications safe and effective), on-call pharmacists to answer questions, and options like split fills (where clinically appropriate) to reduce waste if your protocol changes mid-cycle.
We’ll route prescriptions to the approved pharmacy and assist with any needed transfers (if your plan switches preferred pharmacies mid-cycle) to ensure your treatment timeline isn't disrupted.
While your plan may specify another pharmacy, here are some commonly used options:
Protect your fertility medications (and your wallet) with these practical but important steps.
Grouped By Brand
For Eligible Oncofertility Patients
For US Veterans & Spouses
For Uninsured or Underinsured Patients
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