Medical coverage & (in)fertility: it’s all about the benjamins baby!

Unfortunately for us (in)fertiles, money can often be a deciding factor in how and when we proceed with treatment.

My husband and I both have family medical coverage via our employers through Great-West Life (GWL). Family coverage means that whatever isn’t covered on my plan goes through his for extra potential reimbursement.

As far as I know, it’s NOT common in Canada to have a medical insurance plan that covers IVF. I could be wrong though. Some provinces subsidize treatments depending on your medical history, but our province does not.

We do have decent AMAZING fertility drug coverage though.

So far, my Clomid + HCG + Prometrium (progesterone capsules) has been 90% covered.

Each IUI cycle costs us $350 for the procedure and about $25 for the drugs. Since our clinic is located over 40km away, we can also claim mileage and meals on our income tax. On paper, if we drive back and forth without a hotel stay, an IUI cycle with oral meds costs us about $700. I’m so glad it’s almost summer now and we don’t have to stay overnight! Canadian winters in the Prairies = harsh winter driving conditions. 

Anyway, I thought maybe calling my medical insurance company would help me decide which treatment option is best for us.

Last time I contacted GWL, they told me I had up to 90% reimbursement for fertility medications with no cap – meaning unlimited fertility drug claims.

I didn’t believe them though.

You know how it is when you get that one Customer Service Rep who tells you the WRONG info and completely screws with your plan. For all I knew, that particular Rep may have only been looking at the oral medications.

I decided to call them back if we ever decided to move to injectibles or IVF – just to be sure. 

This afternoon, I made that call. My current clinic posts a Drug Identification Numbers (DIN) list on their website for all injectible meds that they prescribe. The Customer Service Rep told me she didn’t need the list because my drug coverage would cover any fertility drug up to 90% with no maximum claim amount.

I had her double check like 3x before I would believe her. Lucky me. 

The catch is Femara (a.k.a. Letrozole) is considered primarily as a breast cancer treatment drug. Since it’s an off-label fertility drug, my insurance company requires the prescribing doctor to fill out a prior authorization form before you can fill your prescription and qualify for reimbursement.

Of course, they HAVE to make the easiest next step slightly more difficult for us. Ugh. 

Right now, I am VERY GRATEFUL for our coverage. It makes the thought of moving to injectibles less stressful.

So for now, I will hold tight and keep praying for a BFP this month.

If my stars don’t align, I have until CD1 to make up my mind.

Baby dust to you all! XO. 

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