How many Crinone's?

How many Crinone's?

Anon for this please
Anon for this please

July 8th, 2012, 4:21 pm #1

Hi,
This is the anon poster who had the stuffy nose a few posts below...

When I went for my surprise beta last Sunday, my progesterone level was 8. Nurse said I didn't needed P4 support because I didn't start it around ovulation (this was a spontaneous BFP), but I decided to use leftover Crinone anyway, morning and night. When RE called a couple of days later, he said one a day should be enough, but I've been continuing with 2.

Should I keep going with 2 or reduce to 1 at this point? I'm afraid to, honestly, but we just filled a prescription for 1 week (15 applicators) and it cost us close to $200!

The pharmacy said if they get a pre-auth from the doctor, they'll run it through insurance (or something like that). Should progesterone be run as a regular Rx or does it have to be run through fertility coverage (which we no longer have)? PIO during my last cycle was run as a regular Rx because it's not only used for fertility patients, so I'm not clear on why Crinone would be any different.

Thanks for any advice.
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Mrs. A
Mrs. A

July 8th, 2012, 6:53 pm #2

Have the pharmacy run it through your PRESCRIPTION/PHARMACY benefit.
This will likely trigger a reject at POS (point of sale).
The reject will likely be due to no coverage and/or needing a prior authorization.
At which point your dr. will need to call your insurance (whomever it is that handles your prescription benefit) and explain to them it's for pregnancy and that it's his recommended form of P4 support for you.

It is possible that this medication is rejecting because the insurance wants to confirm why you're using it since it's used for luteal phase support in women undergoing infertility treatment. But you are not using it for infertility. You are using it for a confirmed pregnancy. Or it can be rejecting because it is not on your plan's formulary / approved list of medications. This is very possible since, as you can see, it is VERY expensive. PIO is peanuts compared to Crinone costs.

In lieu of the above you can just call your prescription benefits member services and have them run the medication through price check and advise you on coverage for the medication. If you have online access to your prescription benefits you should be able to do the same.

Once you have the above settled, and hopefully secure coverage, do not forget to submit your most recent Crinone purchase for reimbursement.

P.S. - if they don't cover Crinone at all under any circumstances, then find out if they cover Endometrin or just regular vaginal P4 suppositories (the kind that are waxy bullets), assuming you want to use a vaginal form. Or you can ask about Prometrium capsules which you can take orally or insert vaginally.

As for how much Crinone - Dr. Ch.eck told me one a day was sufficient; I can't remember the exact wording now but it was basically that after 1 insert of Crinone your body's ability to absorb more Crinone from a 2nd is decreased and you only end up with about 10% absorption of the 2nd one. So not much and probably not worth the added expense. However I do know that there have been some women on the boards here who have used multiple Crinone's per day. I think I'd want to know what my P4 was to feel comfortable with making a change. (Btw, Crinone is packaged in 15s to cover a luteal phase / 2 week supply...one a day is the normal Rx. Writing the Rx for more than one a day may also generate a flag for the insurance to confirm the Rx)
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Mrs. A
Mrs. A

July 8th, 2012, 7:02 pm #3

CONGRATS. Duh - should have said that first.

But also wanted to add that if the pharmacy has already run through your prescription coverage and it's rejected for a prior auth, then you should be receiving a notification from your insurance indicating this; it's even possible that the pharmacy received a reject message at POS that contained an 800# for them to call for this PA process. You can also call member services and ask them to review the rejected claim already on file and give you the process for a PA (prior authorization a.k.a. as coverage review) so you can get the ball rolling with that.

or...you can call RE's office, give them the member ID and 800 # for your prescription coverage and they can call and advise they calling in to obtain PA for your Rx.

And P.S. - while they're at it, you should have RE call in your Rx to your mail order pharmacy...you should be able to get a 3 month supply for a much cheaper co-pay than retail. (you should do this regardless of what form of P4 you go on). This is also a way of getting a BIG supply right now under the factual premise of being BFP, but God forbid this BFP doesn't work out, you will have some P4 support on hand for the next time - but we're going to hope for no "next time"!

GOOD LUCK!
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Anon for this please (OP)
Anon for this please (OP)

July 8th, 2012, 7:16 pm #4

Hi,
First, thank you for the congrats! And thank you for this info. You're exactly right... the pharmacy sent a prior auth form to the RE and the RE will have to call the insurance, so I'm going to call the RE first thing in the morning to see if anything can be done. If not, I guess it's not the end of the world. I didn't have any PIO on hand but had the extra Crinone, so I went for it.

Definitely the mail order would have been better, but I realized this morning that I was going to run out today and there's a Walgreen's next door to the RE that dispenses fertility meds, so it seemed like the quickest option.

My only concern is about reducing from 2 to 1. What you say about it not really absorbing the 2nd one fully is new to me, but I have only used Crinone once before and don't know anything about it, so thank you for that info.

Thanks again for your help!
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Mrs. A
Mrs. A

July 8th, 2012, 7:38 pm #5

some plans have special programs where they allow you to receive your mail order meds at a local pharmacy. Maybe your plan has that option? It's not very common but worth looking into if you find this more convenient.

Just make sure you have the REs Rx be made out to maximum possible with refills noted so that you don't have to worry about this again. Oh if you're unsure how long he plans on keeping you on Crinone, make sure that the PA issued is for a period long enough to cover you for the next few months. Otherwise you will have to go through this same process if you try to fill and the PA has expired.
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Anon for this please
Anon for this please

July 9th, 2012, 3:19 pm #6

Hi,
This is the anon poster who had the stuffy nose a few posts below...

When I went for my surprise beta last Sunday, my progesterone level was 8. Nurse said I didn't needed P4 support because I didn't start it around ovulation (this was a spontaneous BFP), but I decided to use leftover Crinone anyway, morning and night. When RE called a couple of days later, he said one a day should be enough, but I've been continuing with 2.

Should I keep going with 2 or reduce to 1 at this point? I'm afraid to, honestly, but we just filled a prescription for 1 week (15 applicators) and it cost us close to $200!

The pharmacy said if they get a pre-auth from the doctor, they'll run it through insurance (or something like that). Should progesterone be run as a regular Rx or does it have to be run through fertility coverage (which we no longer have)? PIO during my last cycle was run as a regular Rx because it's not only used for fertility patients, so I'm not clear on why Crinone would be any different.

Thanks for any advice.
Hi,

I just spoke to the RE's nurse... a few of them actually because I'm so paranoid and everyone seems to think it's ok to reduce to 1. One of them said 2 Crinone's are the protocol for FET's and 1 is their protocol for fresh IVF and spontaneous BFP's. This is totally fine with me. I'd be happy to take just one. I'm just really, really nervous about my body noticing the difference dramatically if I go from 2 to 1. I've been using 2 for a week.

Not sure what to do and they haven't checked my progesterone since the first beta, when it was 8. In any case, Crinone effect doesn't show up in bloodwork.
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smrc
smrc

July 9th, 2012, 4:13 pm #7

after a FET at C.ornell. I eventually tapered to one (around 7 weeks) and then stopped completely around 14 weeks. I completely understand why you're nervous about tapering back so soon. One compromise might be to stick with the 1 x crinone a day, but to take a less expensive p4 oral supplement or suppository such as prometrium or endometrium to supplement? Just a thought. Hang in there. SMRC
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Anon for this
Anon for this

July 9th, 2012, 4:29 pm #8

Hi,
Thanks for this info! I guess my concern is not whether I should take 1 or 2. I'm happy to take 1. I've read (now, a week in) that this is standard for fresh/spontaneous. I'm just nervous about dropping from 2 to 1. Has anyone gone from 2 Crinones to 1 and been ok?

Thanks!
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smrc
smrc

July 9th, 2012, 4:57 pm #9

at 7 weeks, as mentioned, and was OK. SMRC
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Anon for this
Anon for this

July 9th, 2012, 5:35 pm #10

I should have read more carefully

Thanks!
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