Coverage—an Overview

While health insurance plans in general contract to pay a sum of money to the insured in the event of a medical claim in return for the payment of premiums, you may find that there are many variations in coverage. Some health plans require patients to pay large deductibles or limit benefits, while others give broader coverage and require little out-of-pocket expense. As a consumer, it's important to understand your insurance. Below you'll find an overview of insurance types:

Group insurance policies—most people are covered by group insurance policies, which are designed to keep premiums lower by sharing expense risks among members of the group.

Public insurance—insurance provided through government programs such as Medicare and Medicaid.

Private insurance—private insurance usually falls into one of three categories:

  • Commercial insurance—commercial insurance companies such as Aetna, Cigna, Oxford, etc.
  • Non-profit insurance—insurance companies such as Blue Cross/Blue Shield
  • Self-insuring groups—groups, such as employers, who pay claims directly rather than employing an outside insurance carrier

Many insurers are using managed care formats to lower the costs and improve the quality of healthcare. Managed care plans contract with healthcare providers and facilities to provide care for members at a lower cost. Typically, more flexible managed care plans (those that allow you to see out-of-network providers) are more expensive, while those with more restrictive rules tend to be more affordable.

Mandates

You may live in one of the 15 states (AK, CA, CT, HI, IL, LA, MD, MA, MT, NJ, NY, OH, RI, TX, WV) that provide mandates for infertility services. Mandated benefits vary by state. An actual mandate requires insurers to provide infertility coverage, but some states only have a "mandate to offer." A mandate to offer requires insurers to offer coverage, which employers may or may not choose to purchase. Mandated coverage may also depend upon the relationship between you and the insurance carrier. Mandates usually target traditional health insurance companies.

Occasionally, mandates also cover managed care plans that are doing business within a given state. However, Federal ERISA (Employee Retirement Income Security Act) laws exempt self-insured groups from state mandates.

BRAVELLE® (urofollitropin for injection, purified)

BRAVELLE® (urofollitropin for injection, purified) is a prescription medicine that contains hormones. BRAVELLE contains follicle stimulating hormone which stimulates healthy ovaries to make eggs. BRAVELLE is used for women who need medical help to get pregnant. Your doctor may prescribe more than one medicine as part of a pregnancy plan.

Important Safety Information

Do not use BRAVELLE if you: have ovaries that are not able to make eggs even with the use of hormones, are pregnant or think you may be pregnant, have problems with your thyroid gland or adrenal gland that are not controlled by taking medicine, have cancer in your female organs (ovaries, breasts, uterus), have a tumor of your pituitary gland or any other tumor in your brain, or have heavy or irregular vaginal bleeding and the cause is not known.

BRAVELLE may cause serious side effects. It sometimes stimulates the ovaries too much. This is called ovarian hyperstimulation syndrome (OHSS) and can be a serious medical problem. OHSS may cause pelvic pain or breathing problems, or it may make you urinate less. In rare cases, patients with this problem have had serious lung problems. BRAVELLE can also cause blood clots and strokes. Call your doctor or get medical help right away if you have: severe pelvic pain, nausea, vomiting, diarrhea, sudden weight gain, trouble breathing, or decreased or no urination. BRAVELLE may cause you to be pregnant with twins or more than two babies at the same time.

The most common side effects with BRAVELLE are stomach cramps and headache.

Please see full Prescribing Information for BRAVELLE.

MENOPUR® (menotropins for injection, USP)

MENOPUR® (menotropins for injection, USP) is a prescription medicine that contains hormones. MENOPUR contains the hormones follicle stimulating hormone and luteinizing hormone. These hormones stimulate healthy ovaries to make eggs. MENOPUR is used for women who need medical help to get pregnant. Your doctor may prescribe more than one medicine as part of a pregnancy plan.

Important Safety Information

Do not use MENOPUR if you: have ovaries that are not able to make eggs even with the use of hormones, are pregnant or think you may be pregnant, have problems with your thyroid gland or adrenal gland that are not controlled by taking medicine, have cancer in your female organs (ovaries, breasts, uterus), have a tumor of your pituitary gland or any other tumor in your brain, or have heavy or irregular vaginal bleeding and the cause is not known.

MENOPUR may cause serious side effects. It sometimes stimulates the ovaries too much. This is called ovarian hyperstimulation syndrome (OHSS) and can be a serious medical problem. OHSS may cause pelvic pain or breathing problems, or it may make you urinate less. In rare cases, patients with this problem have had serious lung problems. MENOPUR can also cause blood clots and strokes. Call your doctor or get medical help right away if you have: severe pelvic pain, nausea, vomiting, diarrhea, sudden weight gain, trouble breathing, or decreased or no urination. MENOPUR may cause you to be pregnant with twins or more than two babies at the same time.

The most common side effects with MENOPUR are headache, stomach pain, and upset stomach. Sometimes there is an injection-site reaction that can cause bruising, pain, or redness.

Please see full Prescribing Information for MENOPUR.

ENDOMETRIN® (progesterone)

ENDOMETRIN® (progesterone) is a vaginal insert that contains the hormone progesterone, one of the hormones essential for helping you to become and to stay pregnant. ENDOMETRIN is for women who need extra progesterone while undergoing treatment in an Assisted Reproductive Technology (ART) program.

Important Safety Information

Do not use ENDOMETRIN if you:

  • Are allergic to anything in ENDOMETRIN
  • Have unusual vaginal bleeding that has not been evaluated by a doctor
  • Currently have or have had liver problems
  • Have or have had blood clots in the legs, lung, eyes, or elsewhere in your body

Progesterone can increase your chance of getting blood clots. Blood clots can be serious and lead to death. Serious blood clots include those in the legs, lungs, eyes, heart, and brain.

Call your doctor and get medical help right away if you have: persistent lower leg pain, sudden shortness of breath, coughing up blood, sudden blindness (partial or complete), severe chest pain, sudden severe headache, vomiting, dizziness, or fainting, weakness in an arm or leg, or trouble speaking, yellowing of the skin and/or white of the eyes indicating possible liver problems.

Common side effects seen with ART and ENDOMETRIN included pelvic pain after surgery, abdominal pain, nausea, and swollen ovaries (ovarian hyperstimulation syndrome).

Please see full Prescribing Information for ENDOMETRIN.

REPRONEX® (menotropins for injection, USP)

REPRONEX® (menotropins for injection, USP) is a prescription medicine that contains purified hormones. REPRONEX contains the hormones follicle stimulating hormone and luteinizing hormone. These hormones stimulate healthy ovaries to make eggs. REPRONEX is used for women who need medical help to get pregnant. Your doctor may prescribe more than one medicine as part of a pregnancy plan.

Important Safety Information

Do not use REPRONEX if you: have ovaries that are not able to make eggs even with the use of hormones, are pregnant or think you may be pregnant, have problems with your thyroid gland or adrenal gland that are not controlled by taking medicine, have cancer in your female organs (ovaries, breasts, uterus), have a tumor of your pituitary gland or any other tumor in your brain, or have heavy or irregular vaginal bleeding and the cause is not known.

REPRONEX may cause serious side effects. It sometimes stimulates the ovaries too much. This is called ovarian hyperstimulation syndrome (OHSS) and can be a serious medical problem. OHSS may cause pelvic pain or breathing problems, or it may make you urinate less. In rare cases, patients with this problem have had serious lung problems. REPRONEX can also cause blood clots and strokes. Call your doctor or get medical help right away if you have: severe pelvic pain, nausea, vomiting, diarrhea, sudden weight gain, trouble breathing, or decreased or no urination. REPRONEX may cause you to be pregnant with twins, or more than two babies at the same time.

The most common side effects with REPRONEX are headache, stomach pain, and upset stomach. Sometimes there is an injection-site reaction that can cause bruising, pain, or redness.

Please see full Prescribing Information for REPRONEX.

NOVAREL® (chorionic gonadotropin for injection, USP)

NOVAREL® (chorionic gonadotropin for injection, USP) is a prescription medicine that contains a hormone to help stimulate healthy ovaries to make eggs. NOVAREL is used for women who need medical help to get pregnant. Your doctor may prescribe more than one medicine as part of a pregnancy plan.

Important Safety Information

Do not use NOVAREL if you have begun puberty at an unusually early age, have prostate cancer, or have had a prior allergic reaction to this hormone. This hormone may cause harm to an unborn baby when given to a pregnant woman.

NOVAREL may cause serious side effects. It sometimes stimulates the ovaries too much. This is called ovarian hyperstimulation syndrome (OHSS) and can be a serious medical problem. OHSS may cause pelvic pain or breathing problems, or it may make you urinate less. In rare cases, patients with this problem have had serious lung problems. NOVAREL can also cause blood clots and strokes. Call your doctor or get medical help right away if you have: severe pelvic pain, nausea, vomiting, diarrhea, sudden weight gain, trouble breathing, or decreased or no urination. NOVAREL may cause you to be pregnant with twins or more than two babies at the same time.

Other side effects of NOVAREL include headache, irritability, restlessness, depression, fatigue, swelling, and pain at the site of injection.

Anaphylaxis has been reported with urinary-derived hCG products.

Please see full Prescribing Information for NOVAREL.

You are encouraged to report negative side effects of prescription drugs to the FDA.
Visit www.fda.gov/medwatch or call 1-800-FDA-1088.