Cost of Clomid with and without Insurance
The cost of Clomid (Clomiphene Citrate) both with and without insurance is modest. However, the side effects may require future parents to spend far more.
The most obvious side effect is a successful pregnancy, which requires a far different discussion. You can dramatically reduce expenses by acting prior to conception!
You can find ways to reduce your expenses through insurance coverage, and with IRS discounts.
- Discounts for out-of-pocket costs
- Finding direct and indirect coverage
Cost of Clomid without Insurance
The cost of Clomid without insurance is easier to determine but more difficult to swallow. Spending can rise quickly without a third party plan picking up most of the tab. You can reduce your out of pocket costs by shopping around, and by taking advantage of hidden discounts.
Out of Pocket Costs
Clomiphene Citrate (Clomid) prices without insurance are modest. The average out of pocket cost of a cycle ranges from $35 to $70 depending upon dosage and quantity. Prices for non-generic versions run higher, which is one reason why fertility drugs are so expensive.
Prices show modest variation between Costco, CVS, Walgreens, and Walmart. They all seem to quote a very high initial price, and then something far more affordable and competitive with a coupon. Make sites make it very easy to print coupons providing significant discounting.
Paying for Clomid yourself may not break the bank, but you may graduate to protocols that are more expensive if the treatment does not help you conceive.
If you are having trouble conceiving, your doctor may start you on a Clomid cycle first, as it is relatively inexpensive, and taken orally. You will either conceive or graduate to treatments that are more expensive.
You may want to learn how to leverage discounts right away. The IRS provides Clomid discounts and interest-free infertility financing for couples willing to think ahead.
For most patients, the best tax strategy comes via your Flexible Spending Account (FSA). Schedule A allows you to deduct expenses, but only amounts above 10.0% of adjusted gross income. Clomid is inexpensive, so it is unlikely that total expenditures will reach this high. Your FSA provides first dollar savings.
Purchase your prescription Clomid using funds from your FSA. Your prices will be reduced by the percentage of federal, state, and FICA taxes you pay. Some pharmacies will even allow you to use your FSA debit card when you buy online.
Cost of Clomid with Insurance
The average cost of Clomid with insurance is almost impossible to determine. Very few couples are fortunate enough to have a plan that covers infertility. When they do, the plan designs differ widely.
You can find infertility health insurance coverage through creative approaches. Supplemental policies lower costs, but very few couples take advantage – even though they should. Perhaps you will be one who makes the smart choice.
Traditional Health Insurance
The cost of Clomid with traditional health insurance coverage depends on your plan design. Traditional healthcare coverage is very rare, as most plans do not directly cover any infertility treatment.
If you are lucky enough to find health insurance that covers infertility, there are still direct costs of Clomid to consider. Carriers like Kaiser and Blue Cross Blue Shield cover infertility only when required by state law.
Prescription Drug Plans
Since Clomid is a prescription drug, your plan formulary determines what you spend. A formulary is the list of prescription drugs covered by the plan.
Each formulary assigns a different copayment, which may be expressed in whole dollars or a percentage of the allowed charges. Most plans have three levels of copayment that may be required:
- Generics – have the smallest copayment
- Preferred brands – have larger copayments
- Non-preferred brands – have largest copayments
Supplemental Health Insurance
The average cost of Clomid with supplemental health insurance is often much lower when you consider the resulting pregnancy. Supplemental plans are more widely available, and more easily obtained than traditional plans.
Short-term disability insurance for pays dividends when two intended Clomid side effects occur. Pregnancy is the primary side effect. Multiple pregnancies also frequently occur.
Lost income during maternity leave and hospital admission charges are two hidden downstream Clomid costs. Supplemental policies cover both of these losses. Additional benefits may be paid when twins or triplets spend time in neonatal intensive care.
You must purchase these policies prior to conception!
Posted February 27, 2013 by Kevin Haney
Fertility drug: Clomiphene
Clomiphene citrate can help you get pregnant if:
Depending on your fertility issues or overall health, a doctor might prescribe drugs other than clomiphene. Find out more about fertility drugs for women .
Does clomiphene work for men?
Clomiphene can help men who have a hormonal imbalance linked to low sperm count, or poor sperm quality or motility.
What’s clomiphene treatment like?
Clomiphene treatment can be an emotionally intense process for some women because they’re anxious about their body’s response to the medication. Women taking clomiphene also have to go to the doctor’s office frequently for monitoring.
Here’s how it works:
- Taking the drug. You take a clomiphene pill for five days at the start of your period. This helps your body produce more follicle-stimulating hormone (FSH), which makes the follicles grow. Follicles are the fluid-filled sacs where eggs mature.
- Looking for the surge. After five days of taking clomiphene, your brain releases a “surge” of luteinizing hormone (LH), which signals the ovaries to release one or more mature eggs from the follicles when you ovulate. The LH surge happens five to 12 days after you take the last clomiphene pill.
- Waiting for the release. The doctor monitors you closely to see whether your ovaries are ready to release an egg. A blood test or ultrasounds are done to monitor how the follicles are developing. You may also be asked to use an ovulation predictor kit or a basal body temperature chart to detect when you ovulate.
- Timing the conception. Monitoring when eggs are released helps your doctor figure out the ideal time for you and your partner to have sex, or the best time to schedule a procedure such as IUI. And when an egg meets a healthy sperm in the fallopian tube, there’s a chance you’ll conceive.
How long does clomiphene treatment take?
It depends on how regular a woman’s menstrual cycle is and how many times she has to try before she gets pregnant.
It can take a month or two of drug therapy – with a dosage increase, if necessary – before ovulation begins. Once ovulation occurs, it can take three to six cycles of treatment. Most doctors don’t recommend using clomiphene for more than six treatment cycles.
- For a regular period: Clomiphene is taken for five days, two to five days into a period. To figure out when your next period begins, use our ovulation calculator .
- For an irregular period or no period: A medication called medroxyprogesterone acetate is taken for 10 days to get a period started. Clomiphene is taken after the period begins.
If you don’t succeed after three cycles, the doctor might add another medication or suggest a different treatment.
What are the side effects of clomiphene?
Most women tolerate clomiphene well, but for some it causes minor side effects, including:
- Mood swings
- Hot flashes
- Thick and dry cervical mucus
- Pelvic pain
- Breast tenderness
- Ovarian cysts
- Mild depression
- Blurred or double vision (though this is less common)
What are the risks of clomiphene?
There’s a 5 to 12 percent chance of conceiving twins with clomiphene. (Less than 1 percent of women conceive triplets or more.) Though many couples consider it a blessing, carrying multiples increases your risk of miscarriage. preterm labor, and other complications.
In very rare cases, clomiphene causes a mild form of ovarian hyperstimulation syndrome (OHSS), which can lead to weight gain and a full, bloated feeling. OHSS happens when the ovaries respond too well to fertility drugs and produce too many eggs. The ovaries quickly swell to several times their normal size and produce fluid that leaks into the abdomen.
Mild OHSS usually goes away on its own with bedrest and careful monitoring by a doctor. But in very rare cases it’s life threatening – and hospitalization or more intensive monitoring may be necessary.
On the bright side: Contrary to what some researchers thought years ago, recent studies have found that taking fertility drugs such as clomiphene does not increase your risk of developing ovarian cancer. In the past, this was a major source of controversy and concern.
What’s the success rate of clomiphene?
About 80 percent of women ovulate in the first three months of treatment. Of those, 30 to 40 percent get pregnant by the third treatment cycle.
The chance of giving birth to a baby depends on several factors, including age and the quantity and quality of the sperm.
How much does clomiphene cost?
In the United States, expect to spend $10 to $100 on one cycle of clomiphene, depending on your insurance coverage, the dosage, and whether you choose a brand name or generic drug. But this doesn’t include the cost of doctors’ visits, ultrasounds, or follow-up procedures such as IUI. If an insurance policy doesn’t cover the treatment, you’ll probably have to pay the entire cost up front.
See therapists’ top 10 tips for coping with a fertility problem. Visit the BabyCenter Community to discuss clomiphene and similar fertility drugs with others.
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Fertility Drugs Cost
Fertility drugs often are the first treatments recommended for a couple having trouble conceiving, especially as a result of polycystic ovary syndrome (PCOS), a hormonal and metabolic disorder that affects as many as one in ten women of childbearing age. Usually Clomiphene citrate — better known by the brand name Clomid — is tried first because it is relatively inexpensive and is taken orally.
- The typical cost of a one-month cycle of Clomid is $30 to $75 without insurance.
- The typical cost of a one-month cycle of injectables, which usually includes three drugs, ranges from $1,500 to $3,000 per cycle, and sometimes as high as $4,000 without insurance. The average cost is about $2,700 .
- It is more common for health insurance plans to cover infertility drugs than procedures such as IVF, but some prescription drug plans exclude even fertility drugs. Some states mandate insurance coverage of infertility treatment, with some restrictions. The American Society for Reproductive Medicine lists states that require coverage. In most states that mandate coverage, the law applies to group insurance plans of companies with 25 or more employees; individual plans are less likely to cover infertility treatments.
- On FertileThoughts.com, patients share their experiences with various health insurance companies and plans.
- FertilityLifeLines.com, run by an affiliate of Merck Serono, offers advice on navigating insurance benefits and a toll-free phone number 1-866-LETS-TRY, that offers help figuring out what your plan covers. The American Fertility Association [1 ] has a list of questions to ask your insurer.
- For patients covered by insurance, out-of-pocket costs typically consist of prescription drug copays of $10 to $100 per cycle, depending on the drug and the plan. Some insurers cover only a percentage — usually 50 to 80 percent — of the cost of fertility drugs, which can cause out-of-pocket costs to reach as much as a few thousand dollars.
Related articles: Fertility Test. IVF. Artificial Insemination
What should be included:
- With Clomiphene citrate — or Clomid — the patient begins taking two to three 50 mg tablets by mouth, usually about three to five days after the start of her menstrual cycle, continuing for about five days. The drug acts on the brain, tricking it into releasing more follicle-stimulating hormone (FSH), which can cause the patient to ovulate. The American Fertility Association [2 ] has an overview of Clomid.
- If Clomid does not work, or causes intolerable side effects, doctors can use injectable fertility drugs. The American Fertility Association [3 ] has an overview.
- While taking the drugs, the patient must be monitored via blood tests, which measure hormone levels, and transvaginal ultrasounds, which show follicle size and endometrial thickness — indicators of how the treatment is working. Monitoring can costs hundreds of dollars per cycle.
- Drugs — especially injectables — often are used in conjunction with artificial insemination, which costs about $300 to $500 per cycle, or IVF, which averages $12,400 per cycle.
Shopping for fertility drugs:
- It is important to take fertility drugs only under the supervision of a qualified doctor. The doctor you choose should be a reproductive endocrinologist, meaning they are board-certified by the American College of Obstetricians and Gynecologists [4 ] and have had at least two to three years additional training in reproductive endocrinology. The American Society for Reproductive Medicine offers a doctor locator.
Material on this page is for informational purposes only and should not be construed as medical advice. Always consult your physician or pharmacist regarding medications or medical procedures.
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