Nexplanon Cost $1200 with insurance!? Anthem

Hey guys!

I’m not sure if this is the right place or tag to post this, but recently I went to see my gyno to get Nexplanon for the first time ever. The process at the gyno was easy, consultation, Pap smear and signing the paper for the office to order the Nexplanon.

So here’s the part that’s been rough. I got a notification from CVS Specialty Pharmacy that my Nexplanon is ready and that I need to call to schedule the delivery to my doctor’s office. Great! I did that. But then they told me my copay will be a $1200. The price before insurance is $2000. Instead of paying I decided to contact my insurance Anthem and they told me all FDA approved contraceptives are 100% covered. They suggested I talk to the CVS/Caremark on why only about a half was covered. So I talked to the CVS person. She told me that the only contraceptive that is covered by my insurance is the vaginal ring and the pill under the ACA. Which I told her no, the ACA covers other contraceptives like the implant and IUD. Also my insurance already told me it is covered! She told me only half was covered because my RX was used and to contact the medical side of the insurance.

How am I suppose to know if the RX was used and not my medical when all I did was provide my medical insurance card at the doctor’s office to place the order?? I didn’t ask for that.

Also, I went to the Nexplanon website to find out the list price for the implant is $1092.48. Why is my copay higher than the actual cost of Nexplanon? Is CVS marking up the price on this? Because $2000 before insurance sounds outrageously overpriced. I know that price doesn’t include the insertion. Which I am assuming should be free as well according to my insurance.

I did contact my doctor’s office for help and contacted CVS Specialty Pharmacy again and explained my situation. Now the entire order is under review again. Who knows how long this will take.

Has anyone had a similar experience or can explain to me why this is happening? And why is the cost so expensive compared to the actual Nexplanon website?

submitted by /u/catskneadingbread
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