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Fertility medications can be one of the most confusing and frustrating parts of the IVF process. In fact, 22% of patients don’t comply with their regimens! We recently had the pleasure of sitting down with Ennio Magnarelli, Pharmacist at Rosemont Pharmacy, to discuss some of the most frequently asked patient questions when it comes to fertility meds.
The bottom line? Your fertility pharmacy should be a resource on your fertility journey, and your choice of specialty pharmacy actually matters more than you might think.
Q&A With Ennio Magnarelli, Pharmacist
KRISTYN HODGDON: Why can’t I get my fertility medication at my neighborhood drugstore, like Walgreens or CVS?
ENNIO MAGNARELLI: While your local drugstore may be able to order some of your fertility medications, they rarely keep any in stock. So, you may have to wait a few days before receiving your medication. It’s also important to note that sometimes non-specialty pharmacies are unaware of the storage requirements for fertility medications since they don’t deal with these types of medications on a consistent basis. Lastly, most times, a patient will pay full retail price on these medications, since most non-specialty pharmacies do not have access to manufacturer discount pricing.
KRISTYN: What is the role of a specialty pharmacy?
ENNIO: A specialty pharmacy is a pharmacy that deals with specialized medication for either complex therapies or serious health conditions. Specialty pharmacies deal with medications that require special handling, storage, or distribution, like many fertility medications.
KRISTYN: What does it mean to compound a medication, and what kinds of fertility medications are compounded?
ENNIO: Medication compounding is the process of combining, mixing, or preparing ingredients to create a medication tailored specifically to the needs of an individual patient. Medications are compounded for various reasons such as preparing them for a different method of delivery (if a patient has difficulty swallowing tablets the compounding pharmacist can prepare the medication in a liquid form), to customize a strength or dose that is not available commercially, to prepare a drug to avoid an allergy or intolerance to a specific nonessential ingredient, to manufacture a drug that is unavailable or in short supply (FDA hand-sanitizer during a pandemic), or just to change the flavor of an oral preparation for a child. With fertility, we see compounding typically for customizing doses for certain medications and making preparations to avoid allergies and intolerances.
KRISTYN: What should the role of a pharmacy be in my fertility journey?
ENNIO: Your specialty pharmacy should be your first stop for questions about your fertility medications. Most specialty pharmacies provide their patients with 24/7 pharmacist or nurse availability through direct after-hours emergency services. Specialty pharmacies can verify and coordinate insurance coverage and prior authorizations for your specialty medication. They can also provide compliance monitoring, injection training, education, and counseling.
KRISTYN: Does my choice of a fertility specialty pharmacy actually matter?
ENNIO: I believe it does. While the pharmacy field is full of trustworthy and competent pharmacists and technicians throughout, finding and utilizing the right specialty pharmacy will go far in making your journey as smooth as possible.
KRISTYN: What types of questions should I ask my pharmacist vs. my fertility nurse?
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ENNIO: Pharmacists, especially specialty pharmacists, are your number one source for information about your specialty medications. Your pharmacist is the best person to answer your “how” questions. How does this medication work? How do I use this patch? How do I inject this Progesterone In Oil suspension? Nurses are probably the hardest working people in healthcare. They are expected to know a lot and do a lot. Your nurse might be best to ask “Why” and “When” questions. When should I start my progesterone in oil? Why do I need to come in for blood work so often? When do I do my trigger shot?
KRISTYN: What sets certain pharmacies apart from others?
ENNIO: I believe it’s the level of service, pharmacy hours, after-hours availability, and insurance verification.
KRISTYN: If you’re a cash-pay patient, what should you look for in a pharmacy?
ENNIO: Besides the obvious, pricing, look for free overnight shipping, free sharps containers and supplies, and injection training videos.
KRISTYN: Why do different pharmacies have the same medications, but offer different pricing?
ENNIO: Different specialty pharmacies have different access to manufacturer discounts. Some pharmacies pass along more of the discounts to the patient than other pharmacies.
KRISTYN: What are discount programs, how do they work, and how can I learn more about them?
ENNIO: For patients who do not have insurance coverage, manufacturers and pharmacy owners looking to help patients with the daunting task of affording to purchase specialty medications by providing discounts off the retail cost of these medications. There are also discounts based on financial status, for military veterans and oncology patients undergoing fertility preservation. Some of the best ones, in my opinion, are Organon’s ReUnite and Ferring’s HEART programs.
KRISTYN: What are some common side effects for fertility medications that I should look out for, and why do they take place?
ENNIO: Most symptoms are minor and can include mild to moderate pain, loss of appetite, nausea, diarrhea, and feeling bloated. In rare cases, worse symptoms can include severe abdominal pain, severe nausea or vomiting, decreased urination, dark-colored urine, shortness of breath, low blood pressure, and excessive weight gain. Most of these symptoms occur because these medications work like naturally occurring hormones and are triggering ovulation.
KRISTYN: What should I do when I receive my box of fertility meds?
ENNIO: Open it immediately and check for storage instructions. We understand that, at first, it can appear overwhelming, but it is important to separate those medications requiring refrigeration from those that need to be kept at room temperature. The pharmacy is only a phone call away. Many pharmacies, much like our own, will schedule a video call with you to guide you through opening the box, so please don’t hesitate to reach out.
KRISTYN: Which common fertility medications need to be refrigerated and why?
ENNIO: Follistim, Gonal, Cetrotide are some of the common specialty drugs that require refrigeration. Typically, this is to maintain the stability of the drug compound and/or to extend shelf life.
KRISTYN: What if I forget to refrigerate a med that needs to be refrigerated. Can I still take it?
ENNIO: Immediately call your pharmacist. Some medications can have temperature excursions, meaning that they can tolerate higher or lower temperatures than those temperatures at which they are normally stored for short periods of time. If they are returned to normal storage temperatures within that period then there is no harm in using them. However, some medications can no longer be guaranteed to be effective once they leave the recommended storage temperature window even for a short time.
KRISTYN: How do patients typically learn to prepare and administer their meds?
ENNIO: Patients can prepare themselves for IVF through a combination of training at their physician’s offices, pharmacy, and online training videos.
KRISTYN: What if you’re afraid of shots?
ENNIO: We always hear this. Between you and me, it’s mostly the men that are afraid! Seriously, your doctor, nurse, and pharmacist team will work with you to get you comfortable. If all else fails, there are services available that will come to your home and administer your injections.
KRISTYN: Thank you, Ennio! This has been so helpful.
In Summary
Receiving that first big box of fertility meds can feel incredibly overwhelming, but your fertility pharmacy should be a resource that you can call if you have any questions or concerns as you navigate the difficult world of IVF. If you are in need of additional support on your fertility journey, join our free fertility community at Rescripted.com. There, you can track your appointments, manage your meds, watch injection training videos, and meet thousands of others who GET IT.
Kristyn Hodgdon is the Co-Founder and Chief Community Officer at Rescripted.