Insurance Coverage for NEXPLANON
You may be able to get NEXPLANON for free.
The cost of NEXPLANON depends on your insurance plan. Once you and your doctor have decided that NEXPLANON is right for you, check with your insurance provider about coverage and cost. You may have a deductible, co-pay, or other charges.
Checking if NEXPLANON is covered
Once you and your doctor have decided that NEXPLANON is right for you, check with your insurance provider to determine your specific coverage.
NEXPLANON may be covered as a medical benefit or as a pharmacy benefit. To find out if you have coverage for NEXPLANON as a medical benefit:
- Step 1
- Call the customer service number listed on the back of your health insurance card. Be sure to write down the names of any people you speak with.
- Step 2
- Tell the representative that NEXPLANON is a physician-administered birth control drug (not a device) and that your physician will:
- Be prescribing NEXPLANON
- Order NEXPLANON for you
- Insert NEXPLANON during an office visit
- Step 3
- Ask the representative if NEXPLANON is covered.
- If the answer is “no,” ask if you have coverage for NEXPLANON as a pharmacy benefit.
- To get information about your pharmacy benefit, you may have to call another number (such as the pharmacy customer service number on the back of your health insurance card) and speak to a different person.
- Repeat steps 1–3.
If NEXPLANON is covered:
- Step 1
- Ask the representative whether NEXPLANON and the insertion procedure are 100% covered. If not, ask about your out-of-pocket costs. You should also ask your health plan representative about coverage and out-of-pocket costs for removal, keeping in mind your insurance may change.
- Step 2
- Ask the person to send verification of coverage to your health care provider, if possible.
- Step 3
- If written verification cannot be provided, write down the name of the person you spoke with and tell your health care provider that your health plan representative told you what you’ve learned about your coverage.
- Step 4
- Make an appointment with your health care provider to have NEXPLANON inserted.
If NEXPLANON is not covered:
- Step 1
- Ask your health plan representative if there are circumstances under which a "medical exception" would be authorized and let your health care provider know the information you received.
- Step 2
- If a medical exception is not available, ask your health care provider whether there are payment plan options to pay for NEXPLANON.
Talk to your health care provider to see if NEXPLANON is right for you.
See a list of questions to discuss with your health care provider.
