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Flex 2002 News:
New Limits for Infertility Benefits and Related Medications
Merck recognizes that when it comes to infertility benefits,
emotions run high. Employees and covered family members who are undergoing
treatment for infertility have strong feelings about the benefits currently
available through the Merck Medical Plan—which are, for the most part, unlimited.
However, it’s important for the Company to offer coverage based on quality
clinical protocols—which exist even in this rapidly evolving area of medical
advances and technological breakthroughs.
Effective January 1,
2002, coverage for infertility-related services under the 90/10, 80/20,
POS and PPO medical options will be modified to include lifetime treatment
limits and prescription drug guidelines. These changes, which are highlighted
below, will ensure that the infertility benefits offered through Merck’s
Plan are clinically-based and appropriate.
Please note that these
new treatment limits and guidelines take effect starting in 2002. Services
provided before then—including those received during the remainder of 2001—do
not count toward these new lifetime limits and are not subject to these
new treatment guidelines.
| For
These Infertility Treatments: |
These
New Treatment Limits/Guidelines Apply: |
| Artificial
insemination |
6
attempt cycles (per patient; per lifetime) |
| Advanced
reproduction treatment (ART)* |
3
attempt cycles (all treatments combined; per patient; per lifetime) |
All
prescription drugs indicated for use in
infertility-related treatment |
Require
prior authorization** |
*
Includes in vitro fertilization (IVF); zygote intra-fallopian
transfer (ZIFT); gamete intra-fallopian transfer (GIFT); cryopreserved
embryo transfers; intracytoplasmic sperm injection (ICSI) or
ovum microsurgery.
** This means that to ensure coverage, you, your doctor or your
pharmacist must call Merck - Medco at 800-458-8001 before your
prescription is filled.
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What This Change Means
To You
If you are covered under the 90/10, 80/20, POS or PPO option, and you are
undergoing treatment for infertility—or you are considering such treatment—keep
in mind:
- Infertility-related
benefit changes take effect January 1, 2002. Services provided before
this date—including those received during the remainder of calendar
year 2001—do not count toward the new lifetime limits and are not subject
to the new treatment guidelines.
- Between now and
year-end you may want to speak with your physician about these changes,
and determine the most appropriate course of treatment for 2001 and
2002.
- You may want to
contact Merck-Medco at 800-458-8001 to find out more about how to receive
prior authorization for infertility-related prescription drugs.
Fast Fact
According to William M. Mercer, a leading health care and management consulting firm, comprehensive infertility benefits with appropriate clinical controls may actually improve outcomes and reduce costs by eliminating the use of inappropriate, covered procedures and allowing specialists to use the most effective, efficient treatment for a specific type of infertility.
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2009 Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Whitehouse Station, N.J., U.S.A.
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Merck recognizes that when it comes to infertility benefits,
emotions run high. Employees and covered family members who are undergoing
treatment for infertility have strong feelings about the benefits currently
available through the Merck Medical Plan—which are, for the most part, unlimited.
However, it’s important for the Company to offer coverage based on quality
clinical protocols—which exist even in this rapidly evolving area of medical
advances and technological breakthroughs.
Effective January 1,
2002, coverage for infertility-related services under the 90/10, 80/20,
POS and PPO medical options will be modified to include lifetime treatment
limits and prescription drug guidelines. These changes, which are highlighted
below, will ensure that the infertility benefits offered through Merck’s
Plan are clinically-based and appropriate.
Please note that these
new treatment limits and guidelines take effect starting in 2002. Services
provided before then—including those received during the remainder of 2001—do
not count toward these new lifetime limits and are not subject to these
new treatment guidelines.
