Clarifications Around the Health Plan’s Carrot Infertility Benefit and Fertility Medications Purchased Through TrumpRx, FertilityInstantSavings.com, or Other Outside Sources

With the launch of TrumpRx.gov and its Fertility Instant Savings (FIS) program, the federal government is now offering discounted pricing on certain fertility medications if you pay out of pocket and not through insurance. To access the pricing, individuals must receive a discount coupon from TrumpRx.gov or FertilityInstantSavings.com. Once approved, the medication can be ordered through an FIS-participating pharmacy and paid out of pocket, as fertility medications purchased through an FIS-participating pharmacy are not reimbursable through the Health Plan’s Carrot benefit.

While FIS pricing appears to offer savings, please note the following important considerations applicable to the infertility benefit with the Health Plan:

• All infertility treatments must be considered medically necessary under the terms of the Health Plan and related to a medical diagnosis of infertility to be covered under the Health Plan’s $30,000 lifetime benefit.
• Infertility treatment must be received from in-network Carrot providers to be eligible for coverage. Infertility treatment received from any provider that is not an in-network Carrot provider is not covered by the Health Plan.
• All infertility treatment-related prescription drugs must be purchased through Carrot Rx (fulfilled by Alto Pharmacy) to be covered under the Health Plan’s benefit. Drugs purchased through TrumpRx, Fertility Instant Savings, or other outside sources will not be reimbursed or covered by the Health Plan.

For more information on the Health Plan’s infertility benefit, visit www.dgaplans.org/infertilitybenefits.