How much is the nexplanon implant without insurance

Ordering

Coverage and billing

Types of coverage

NEXPLANON is covered by most health care plans. If covered, NEXPLANON will be covered as either a medical benefit or a pharmacy benefit.

• Medical benefit: This is the most common form of coverage for NEXPLANON. It means that both the drug and procedure are covered under the same benefit .
• Pharmacy benefit: This is the less common form of coverage for NEXPLANON. It means that the drug is covered separately from the procedure .

Verify each patient's insurance coverage

Insurance coverage varies from patient to patient—it is important to know what coverage the patient has before NEXPLANON is purchased.

Contact her insurance carrier:

• Provide all relevant patient information.
• Request coverage status for both product and procedure. You may be asked for additional details, including appropriate codes and product-related information.

Reimbursement support for health care professionals

The Customer Support Center for NEXPLANON (CSCN) offers reimbursement support through a reimbursement counselor—a single point of contact that is regionally assigned to your office. Contact the CSCN for assistance with:

• Benefits investigations within 1 to 2 business days
• Information on patient co-pay requirements
• Possible billing codes for insertion and removal
• Information on ordering NEXPLANON

Phone: 844-NEX-4321 (844-639-4321)

Hours: Monday–Friday, 8 AM–8 PM ET

Fax: 844-232-2618

How coverage status affects ordering and billing

If NEXPLANON is covered as a medical benefit

NEXPLANON is available through 2 specialty distributors as a medical benefit. Through the Buy-and-Bill process, health care providers (HCP) who have completed the Clinical Training Program can order NEXPLANON from a specialty distributor. The CSCN can conduct a benefits investigation, and if NEXPLANON is covered as a medical benefit, then the HCP can bill the insurance carrier for NEXPLANON and the insertion procedure accordingly.

If NEXPLANON is covered as a pharmacy benefit

NEXPLANON is available through 6 specialty pharmacies as a pharmacy benefit. Through the assignment of benefit (AOB) process, NEXPLANON is paid for by the insurance plan. The specialty pharmacy will ship NEXPLANON to the HCP’s office for the procedure and there is no out-of-pocket cost to the HCP. The CSCN can conduct a benefits investigation, and if NEXPLANON is provided as a pharmacy benefit, the CSCN will forward your pharmacy prescription to the specialty pharmacy required by the insurance plan or to a specialty pharmacy of your choice. For a full list of participating specialty pharmacies, please reference the CSCN Enrollment Form, found at organon-cscn.com.

If NEXPLANON is not covered

The patient can contact a human resources manager or health plan representative to determine if a medical exception can be authorized. Your patient has the option to pay for NEXPLANON with cash or a credit card.

Cost is one of the largest factors in rate of birth control use, and the reduction of such fees gives more women the chance to protect against unwanted pregnancies. The problem? Well, the question of who pays for birth control continues to remain a debated topic – and women are paying for the burden.

Because of those debates, and the ever-changing rules and regulations on what insurance is required to cover, determining what you’ll be paying for your birth control can be difficult.

Below, you’ll find a breakdown of costs for a variety of birth control methods, to help you find which one suits you and your pocket.

How Much Does Birth Control Cost?

There’s no simple answer to this question, and that’s part of the problem. To break it down, we need to look at all of the factors that affect the cost of birth control pills. These are just a few of the strongest factors:

• The type of birth control you’re using or would like to use
• Your insurance policy
• Whether or not you have insurance
• The government

Each factor will have a large or small impact on your cost, and even your access to birth control to begin with. Take a look to see if these factors affect you.

Types of Birth Control

There are great differences in each type of birth control. Some last three years, while others last five or even ten. Others only last as long as you take them every day. Each method affects women differently, and your reasons for choosing a method of contraception are between you and your doctor.

But know that the type of birth control you are currently using, or the brand/type you prefer greatly alters the price you pay.

The most common birth control methods include:

• Birth control pills
• The shot
• Implant
• IUD
• Patch

Less common methods include:

• Sterilization
• The diaphragm
• Tubes tied

The following is a cost breakdown of the most common methods of birth control, with and without insurance.

How much do birth control pills cost?

If you’re asking, know that you’re not alone. When women ask about birth control price they are largely referring to birth control pills since it is one of the most widely used forms of birth control.

It’s noted by Planned Parenthood that birth control pills cost an average of $15 a month with insurance (not including co-pay costs for your doctor visit).

They estimate that the cost without insurance for a one-month supply of estrogen pills, progestin pills, or combination pills is $50 a month, not including the cost of the doctor visit – which you’ll need for the prescription. This adds up to approximately $600 a year. Though prices may be higher, regardless of insurance.

How much does the birth control shot cost?

“The shot,” also known as Depo-Provera, is an injection taken in the arm every three months.

You will need a prescription for this, and it’s a method that isn’t always covered by insurance. Check with your provider to see if it’s covered if you’re interested in this method of contraception.

Depending on the amount of coverage your insurance provides, you could be paying anywhere from $0- $250 for your first shot, and follow-up shots could cost an average of $150. This is regardless of insurance.

Expect to pay the highest amount without insurance, unless you qualify for a reduction in price through your doctor, the brand, or government programs.

How much does the birth control implant cost?

Implants (injected into the arm) are a long-term method of birth control that last up to three years.

Without insurance, or without full coverage, birth control implants such as Implanon or Nexplanon cost $800 (at the most) to be inserted, and up to $300 to have removed.

Aside from the upfront cost, the implant is a great way to save yourself from monthly, quarterly, and annual payments. You may also prefer this method if you have difficulty taking pills every day, or want an effective method that you don’t regularly have to think about.

Your insurance plan may cover some or all of these costs and those associated (check with your provider for coverage details).

How much does the IUD cost?

The IUD is a small T-shaped device that is inserted into your uterus, delivering hormones or using copper to neutralize sperm to prevent pregnancy. It’s one of the most effective (99%) contraceptive methods.

Though it is one of the most popular forms of long term birth control, lasting as long as ten years, only 6.4% of women within reproductive age were reported by the CDC to use such method (in 2011-2013).

While those numbers have been going up in recent years due to changes in government regulations on insurance, the cost of IUDs remains a burden for many women.

If you have an insurance policy that covers the cost of the IUD, you may only bear the responsibility of your co-pay. Others may need to pay a portion of the insertion or removal costs.

If you don’t have insurance, or your insurance doesn’t cover the IUD, you may end up paying up to $800 for brands such as Mirena or ParaGard. Since it’s a method that lasts for 5-10 years and can be forgotten during that period without consequence, the benefits are considered to outweigh the upfront cost.

How much does the birth control patch cost?

The birth control patch works in the same way that birth control pills do, only it’s placed on your skin like a sticker. Unlike the pill though, you do not have to think about it every day – each patch lasts one week.

The birth control patch price is also similar to birth control pills: $15-$50 a month, which can add up to $600 each year. What you will pay is reliant on how much your insurance covers. If you do not have insurance, you’ll likely pay the maximum unless you qualify for reduced-cost programs.

Does Insurance Cover Birth Control?

The Affordable Care Act, also known as Obamacare, gave access to millions of women by requiring insurance to cover birth control without cost. This meant women were able to access birth control without copays, and received their birth control for free.

Even with this requirement, women aren’t always given the choice of which birth control is covered. Depending on your insurance plan, generic brands of birth control pills may be the only free option while other methods or brands remain costly.

There are other exemptions as well (as of 2015), and the chances of being affected are possible. The following are the insurance plan exemptions for birth control coverage:

Grandfathered plans: any plan purchased before 2010 and continually held by the insured do not have to provide coverage for birth control if they did not previously cover such costs.

Religious employers: plans provided by religious employers do not have to provide coverage for birth control, though coverage is often offered through a third-party provider.

Alternative plans: providers offer one plan that can be selected in the case of religious or otherwise controversial coverage of birth control.

Short-term health insurance: plans that are not to be held long term, such as travel insurance, is not expected to provide coverage for birth control.

As mentioned, some insurance providers are only required to provide one birth control method for free, and this may not be the type of contraception or brand that you prefer. Contact your insurance provider to see what they cover and if there are any exemptions or costs to you.

If you don’t have insurance and can’t afford birth control without it, there are other options, including some offered by the government – the final most impactful in the cost of your birth control.

Government Regulations

While regulations regarding insurance and what they are required to cover changes, making it harder for some women to obtain the contraception they need, other forces within the government make it easier.

For instance, state regulations don’t always adhere to the federal regulations regarding insurance. Each state government has the power to create laws and regulations on insurance and what they are required to cover when it comes to birth control.

This means that, depending on the state you live in and the insurance you carry, you may be able to get free birth control.

Medicaid may also grant free birth control to those who qualify.

How Much Does Birth Control Cost Without Insurance?

Cost is one of the largest barriers between women and birth control, and not having insurance dramatically increases the cost.

In 2016, approximately 10.5 million women between the ages 19 to 64 were uninsured, according to KFF. That’s nearly 11 million women without access to birth control, or who are paying full price for protection.

And because you need, at the very least, a birth control prescription for any contraception you choose, the cost is even greater.

So, what can you do about this?

How to Get Birth Control at a Reduced Cost (or Free)

If you’re one of the millions of women in the United States without insurance, know that you still have options for obtaining the protection you need. The options below are a good place to start.

Seek out generic brands: speak with your doctor about the most affordable brands for you, and which will be best suited. Know that each woman reacts differently to each method.

Call in your prescription: sometimes a doctor’s visit isn’t necessary. If you have an established prescription with your doctor, you may be able to call in and ask for a refill without paying the co-pay for a visit.

Consider an IUD: because IUDs last for so long, many women choose to pay the upfront costs to avoid paying for the next ten years.

Check with your brand: some brands offer voucher programs or reduced costs to those without insurance.

Medicaid: check to see if you qualify for Medicaid or other government programs that will provide you coverage for your birth control (IUDs are free with Medicaid).

Ask your doctor: your doctor may be able to help you get your birth control at a reduced cost, or possibly free, depending on various factors. They may also be able to help you find a method that is the most affordable. This also applies to those with insurance. If there is a method or brand that you are most comfortable with, but it is not covered by your insurance, your doctor may be able to work with your insurance to get it covered.

Where to Get Birth Control

Where you get your birth control matters. Always speak to a licensed professional who understands all of your birth control options to find the one that’s best for you.

Eastside Gynecology takes the time to understand you and your needs. Call for more information or to make an appointment today.

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