Warning to anyone who has PICA for prescription injectible coverage--I.E. NYC employees

I've been through hell the past few days. Thankfully, it looks like everything will be resolved, but I just wanted to share what I learned. I wouldn't want someone else to get screwed.

Under the PICA plan NYC employees and dependants are entitled to 3 cycles of injectible fertility meds (and they define a cycle as a 28-30 day supply). However, there is a loophole that PICA is using. Apparently, they are going my number of claims, not cycles. So, make sure when your dr. is prescribing meds that it is on one prescription. In my case I needed 2 600ius of follistim and 1 300ius. Since they are different dosages, you need 2 separate scripts, which translates into 2 claims and will count as 2 cycles against you. The way around it is to make sure your dr. prescribes the same dosage on one script. The two claims were literally called in within a minute of each other and they would not budge. Thankfully, I got the pharmacy to reverse the lesser of the 2 and I paid out of pocket so that they would cover my large order I need for IVF this cycle.

If this just helps one person avoid getting put through the ringer, all my aggravation will be well worth it.

Re: Warning to anyone who has PICA for prescription injectible coverage--I.E. NYC employees

that is annoying. I had 2 different meds (repronex and bravelle I think), does that count as cycles?

Thanks for the warning.

Re: Warning to anyone who has PICA for prescription injectible coverage--I.E. NYC employees

That is soooo Absurd, and very slimy of insurance company IMO.

Re: Warning to anyone who has PICA for prescription injectible coverage--I.E. NYC employees

From what I am understanding, if the meds are in different "classes" they count separately.

So, bravelle would be an FSH (like follistim), but repronex is in a different class, so I think you should be okay.

Talk about slimy. That's the city for you!!!