By Sue Taylor of IVF Traveler:
If you are thinking of traveling abroad for IVF, or even doing IVF domestically, often the excluded expenses (such as travel and medications) can add up to as much as your treatment cost. One of the ways you may be able to keep your costs lower is by obtaining the IVF medications abroad.
In some cases, this may save you hundreds or even thousands of dollars in medication costs. But there are a few things you need to know before you get started.
What You Need To Know
First, find out what, if any, medications are included in the price of your treatment. Also get a list from your clinic of what medications you will need and the typical dosages. You can usually get a standard list even before you get your specific protocol. Find out if the clinic allows you any options for progesterone or any of the other medications. Some clinics will offer patients a choice of PIO (progesterone in oil) shots, along with oral or vaginal gels and suppositories or inserts. It is also a good idea to get the generic names of medications or alternatives since brands may vary from country to country. Find out all options or alternative drugs so you can compare prices on them all. Now you can start your research.
There are two potential scenarios: 1) you can get a prescription for the medications from a United States or Canadian doctor; 2) you can’t or don’t want to get a prescription locally and need to get the prescription from your IVF Clinic abroad. Let’s explore these separately.
Prescriptions written by United States or Canadian doctors
The first thing I suggest is checking with your own insurance company to see which medications may be covered if you were able to obtain them locally. Often the estrogen, progesterone, and sometimes blood thinners (if needed) may be covered even if you don’t have insurance coverage for IVF treatments. Sometimes patients will even find that the ovarian stimulation medications are covered – much to their surprise. If your IVF clinic is not in the United States or Canada, you will need to get a prescription from a local doctor in order to get the medications in North America. If you find that many of the medications are covered by your insurance or only have small c0-payments, it may make sense to check with your local doctor (OB/GYN or Reproductive Endocrinologist) who will be monitoring before and after your treatment abroad to see if they will write the prescriptions requested by your international IVF clinic so you can get them through your insurance.
Usually a request letter written by your international IVF clinic’s treating doctor to the local doctor who will be doing any local monitoring will suffice. It should list your name, date of birth, your treatment, and what medications and dosages will be required for treatment. Be prepared, because some United States and Canadian doctors will sit you down for the “scary talk” and try to discourage you from traveling abroad for treatment. I usually suggest calling a clinic in advance and asking over the phone if they will monitor you for an IVF cycle out of the area. Their response will give you a good idea of whether they will be supportive or not. If you have options, try to stay away from the doctors who are not supportive – you simply don’t need this extra stress while you are preparing for your treatment. In my experience, it is only a small number of doctors who have the attitude that the United States or Canada are the only places to go for treatment – and of all that I have encountered with that attitude, NONE of them had ever been to visit a reputable clinic abroad. One more thing before I get off of my soapbox, I think that probably at least 25% of the patients I help with travel abroad for IVF are nurses, doctors or are employed in the healthcare industry. And to date, I have never had a single one that was disappointed in the care they received abroad – in fact, they usually go out of their way to tell me that their care abroad was at least as good if not better than the care they received in the United States or Canada.
Even if some or all of your prescriptions aren’t covered by your insurance, sometimes it is still as cheap or cheaper to get them in the United States or Canada. But you should check around, and most pharmacies in Canada and Europe will fill prescriptions from United States doctors. I can personally recommend three sources.
Freedom Fertility Pharmacy www.freedomfertility.com is a reputable pharmacy based in the United States. Their prices are usually very competitive, and they specialize in fertility medications so their staff is well trained in understanding how to handle and administer these medications. They have a toll free phone number, and have nurses on staff to answer any questions you may have about your medications. They also are a great resource for online videos to help you with administering your injectible medications. They can have medications to you overnight or in a few days usually.
Another reputable site I have used is www.NorthwestPharmacy.com in Canada. Last I checked, they would not ship overnight to the United States, so check with them (they have a toll free number) to verify if you need temperature controlled meds. They actually ship some of their medications from Europe – so even though they are close to the United States – you should still plan 2-3 weeks to get an order from them. They are a good resource if your insurance doesn’t cover the medication or your co-pay is high. For some items like Lupron Depot, they are often cheaper than any other online pharmacies because they offer a generic version not available in the United States.
One popular online site is www.IVFMeds.com in Europe. Their prices are usually pretty competitive, and often cheaper than United States pharmacies. They have a toll free number for North America that is staffed by English speaking representatives, making it easy to communicate with them. One of the benefits of using IVFMeds.com is that they do offer expedited shipping which makes them a great source for temperature controlled medications.
Prescriptions Written By Your Treating IVF Clinic
If getting medications under your insurance is not an option, or isn’t cost effective, or your local doctor isn’t being helpful, there are several other options to explore. They all involve having a prescription written by your international IVF clinic. Usually they can fax this to you – or directly to the pharmacy you plan to use.
You will want to order medications abroad very early in your process. Expect it to take between 3 – 4 weeks from the time you request the prescription to when they make it through customs and to your door. The actual shipping time to the United States from Europe is usually around 2 weeks, but sometimes customs can delay them a bit longer. So, order early!
Check with your clinic to see if they are affiliated with any local pharmacy where you can order your medications. That way your clinic can just send the prescription to their local pharmacy and the pharmacy can ship the medications out to you. Check their prices to see how they compare to some of the bigger online pharmacies abroad that specialize in IVF medications.
The online site www.IVFMeds.com that I mentioned earlier is also a good resource with your prescription from a European IVF Clinic. Their prices are usually pretty competitive, but are sometimes higher than the clinic affiliated pharmacies. One of the benefits of using IVFMeds.com is that they do offer expedited shipping. Many of the other European pharmacies will only ship meds through the regular post (which comes through our post office) due to trying to avoid problems in customs. However, if you are ordering medications that must be kept chilled, then you need a pharmacy that can ship overnight. IVFMeds.com is the best European source I have found for this, and they offer a toll free number in North America and English speaking representatives that you can talk to on the phone.
Since most of the medications that require refrigeration are for IVF stimulation (IVF using your own eggs), check with your clinic to find out exactly when in the process you will need the medications. In some cases, you can just obtain many of them from the clinic affiliated pharmacy once you arrive at the city where your clinic is located– or you can just get enough of what you need before you go and get the rest when you arrive if it is cheaper at the clinic affiliated pharmacy.
In any case, when ordering from a European pharmacy make sure you understand how long it should take to receive the medications and what they will do to resolve the issue if the medications do not arrive safely through customs. Do a little online research if possible to see what other patients are reporting about the pharmacy, and check with your clinic to see what pharmacy they recommend.
Is It Worth The Effort?
Here is a quick example of potential savings from purchasing from a European or clinic affiliated pharmacy for common IVF medications:
|Medication||United States Price||European Price|
|Lupron Depot 3.75mg||$620||$200 (for equivalent Diphereline)|
|Lovenox– box of 10||$355||$ 41 (for equivalent brand Clexane)|
|Gonal-F 900IU pen||$780||$550|
|Crinone 8% progesterone (qty15)||$203||$32|
Regardless of how you go about getting your medications, make sure you consult with your IVF clinic about your specific protocol and clear it with them before allowing the pharmacy to substitute any medications.
Overall, while doing all of the comparison shopping is time consuming, it may be worth it if you can save hundreds if not thousands of dollars depending on the medications you will need for your cycle.
I wish you happy and successful IVF travels.
By Sue Taylor, IVF Traveler - IVF Coordinator & European IVF veteran. Helping patients navigate IVF treatments abroad. Follow my blog onlineivftraveler.wordpress.com or you can contact me at email@example.com.