Specialty Pharmacies ImageBecause infertility treatment typically involves a complicated therapy regime, it requires the use of medications that must be injected and/or refrigerated, and often requires close monitoring by a pharmacist or nurse, certain specialty pharmacies focus solely on patients with infertility. Of the more than 57,000 pharmacies in the United States, only about 125 specialize in infertility.

What is a specialty pharmacy?

A specialty pharmacy is a pharmacy exclusively dedicated to providing medications that require special storage, handling, or specialized knowledge of the condition being treated. These medications are usually high-cost, complex, and are not immediately available at regular retail pharmacies.

How does a specialty pharmacy work?

Specialty pharmacies operate in the same manner as standard pharmacies. Patients may submit their prescriptions by fax, email or in person (for pharmacies with physical locations); or the fertility clinic may submit the prescriptions directly.

What are the benefits to using a specialty pharmacy?

  • Pharmacists and nurses with expert knowledge of infertility treatment
  • A large stock of fertility medications, including compound medications
  • Live telephone support to help you understand how and when to take your medicine
  • Express shipping of medication to a convenient location
  • Assurance that the medications will be properly refrigerated and insulated before and during shipping Appropriate supplies, such as needles, syringes, alcohol swabs, included with the medication
  • Coordination with your doctor to ensure that you are on the right therapy

How do I receive my medicine?

Many fertility medications require refrigeration and other special handling. For this reason, specialty pharmacies are equipped to send your medicine by express shipping (24-48 hours) in well-insulated packages to the location most convenient for you, be it your home, doctor’s office, or another suitable venue. If the pharmacy has a physical location, you may also pick up the medicine there.

How do I choose the right specialty pharmacy for me?

If your health insurance does not require use of a particular pharmacy, choose the specialty pharmacy whose benefits best suit your needs. For example, some offer round-the-clock live support from a pharmacist or nurse. Others offer free express shipping to any location within the U.S. Still others may offer discounted prices, a good financing program, or help you with your insurance paperwork. Consider which benefits will make your life easier as you go through treatment. Most important, always confirm that the pharmacy will have medications and supplies sufficient for your entire cycle.

Do specialty pharmacies take insurance?

Short answer, yes.
Specialty pharmacies not only take insurance, but many have staff to conduct insurance pre-screenings. In this process, the pharmacy collects your insurance information and verifies the type and extent of your coverage. If you are covered, many pharmacies will complete and submit all the necessary paperwork to your insurance company. If you do not have insurance, most specialty pharmacies offer discount and financing programs to help you pay for your medications.

If do not have insurance, can I still use a specialty pharmacy?

The majority of specialty pharmacy customers pay out-of-pocket. For those customers who do not have insurance and cannot afford the cost of these often expensive medications, virtually all infertility specialty pharmacies offer financing programs to help foot the bill.

Tips on using special pharmacies:

Tips from a Financial Counselor at a RE office:

Pro Tip #1: For patients that have a dollar limit for infertility on their insurance that includes medication costs in that limit, I always suggest that patients question the pharmacy on how much they are billing the insurance for the meds vs. how much the self-pay price is. Pharmacies often charge the full “regular” rates to the insurance which can quickly eat up a large chunk of your benefits; there is usually quite a savings if you self-pay for the medications vs. having them billed to the insurance. Patients then can even turn in the receipts and bill the insurance themselves if they still have remaining infertility benefits. That way, the lower rate that they paid is taken from their benefits instead the higher rate that the pharmacy would have billed. I’ve had some patients tell me that it saved them over $1,000 (and even as much as $3,000 SAVED) by doing this. For patients that may have a $10K or $15K limit, this is HUGE and could be the difference between having enough benefits to cover the cycle or maxing out on benefits.

Pro Tip #2: If someone is lucky enough to have insurance, really look into the prescription drug coverage. Your HR rep many not know that your company even has an in network specialty pharmacy. It was very unclear what this was on my insurance website and I just barely found out about it by looking up my prescription drug coverage and calling Triessent.

Contributed by DesignRX.