Implanon® (etonogestrel implant) 68 mg

Health plan coverage

Although IMPLANON is covered by many insurance plans, coverage varies from one plan to the next and can depend on your employer’s benefit design.

You will need to check with your insurance provider to determine whether your plan will cover IMPLANON.

In the process, you will also need to find out if it is covered as a medical benefit or a pharmacy benefit. Typically, IMPLANON is covered as a medical benefit. Medical benefits may cover in-office procedures that include visits, lab work, medicines or products that you might receive. If IMPLANON is not covered as a medical benefit, it may be covered as a pharmacy benefit.

How to start

You can start your research by finding out if IMPLANON is covered as a medical benefit:

  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.

  2. Tell the representative that IMPLANON is a physician-administered drug (not a device) and that your physician:

    • Has prescribed IMPLANON

    • Will order IMPLANON for you

    • Will insert IMPLANON during an office visit

  3. Ask the representative if IMPLANON is covered. You may be asked to provide the following codes:

    • NDC: 0052-0272-01 or 00052-0272-01

    • Billing code: J7307

    • Insertion procedure codes: 11981 or 11975
      (These are possible codes your insurance provider may use. Merck makes no guarantee that the use of any particular code will result in coverage or reimbursement.)

If the answer is “no”, ask if IMPLANON is covered as a pharmacy benefit.

You will likely 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 IMPLANON is covered

  1. Ask the representative whether IMPLANON is 100% covered. If it’s not, ask about other costs you may have.

  2. Ask the person to send verification of coverage to your healthcare provider, if possible.

  3. If written verification cannot be provided, write down the name of the person you spoke with and tell your healthcare provider that IMPLANON is covered.

  4. Make an appointment with a trained healthcare provider to have IMPLANON inserted.

If IMPLANON is not covered

Remember: “No” is not necessarily the final answer. You have other options:

  1. Ask your health plan representative if there are circumstances under which a “medical exception” would be authorized.

  2. Speak with your employer or human resources (HR) manager to see if they can help. You can inform them of the advantages of covering IMPLANON by printing the information from this page and optionally providing them with the Patient Information.
    Mention that you and your healthcare provider believe IMPLANON is a good birth control option for you.

  3. Remember, it is always your option to pay for IMPLANON.

    If this is your choice, tell your healthcare provider you would be willing to pay out-of-pocket.

Be sure to contact your healthcare provider and let him or her know what you’ve learned about your coverage.

IMPLANON is for the prevention of pregnancy in women.

IMPORTANT SAFETY INFORMATION

  • IMPLANON does not protect against HIV (AIDS) or other sexually transmitted diseases.
  • IMPLANON must be removed by the end of the third year and may be replaced by a new IMPLANON at the time of removal, if continued contraceptive protection is desired. Failure to remove IMPLANON may result in infertility, ectopic pregnancy, or inability to stop a drug-related adverse event.
  • After you receive IMPLANON, check that it is in place by pressing your fingertips over the skin of your arm where IMPLANON was placed. You should be able to feel the IMPLANON rod. If IMPLANON is not placed properly, it may not prevent pregnancy or it may be difficult or impossible to remove.
  • Serious consequences may be associated with the insertion and removal of IMPLANON. This may result in the need for a surgical procedure in an operating room in order to remove IMPLANON. Difficult removals may cause pain and scarring, and may result in damage to nerves and blood vessels. In clinical trials, 9 out of 942 (1.0%) patients had complications at implant insertion and 15 out of 942 (1.7%) had complications at implant removal.
  • You should not use IMPLANON if you are pregnant or think you may be pregnant, have or have had blood clots, have unexplained vaginal bleeding, have liver disease, have or have had breast cancer, or if you are allergic to anything in IMPLANON.
  • The use of IMPLANON and other progestin-only hormonal contraceptives have been associated with ectopic pregnancy, bleeding irregularities, and ovarian cysts. The use of hormonal contraceptives is associated with increased risks of several serious side effects including blood clots which may lead to stroke or heart attack. Blood clots are a side effect of birth control pills and pregnancy. It is unknown if the risk of blood clots with IMPLANON is different than with birth control pills. Some examples of blood clots are deep vein thrombosis (legs), pulmonary embolism (lungs), retinal thrombosis (eyes), stroke (head), and heart attack (heart). There have been reports of blood clots, including pulmonary emboli and strokes, in patients using IMPLANON. Tell your doctor at least 4 weeks before if you are going to have surgery or will need to be on bed rest, because you have an increased chance of experiencing blood clots during surgery or bed rest.
  • Cigarette smoking increases the risk of serious cardiovascular side effects from the use of hormonal contraceptives. The risk increases with age (women > 35), and with heavy smoking. Women who use hormonal contraceptives are strongly advised not to smoke.
  • The most common side effect of IMPLANON is a change in your menstrual periods. In studies, about 1 in 10 women stopped using IMPLANON because of bleeding problems. Expect your menstrual periods to be irregular and unpredictable throughout the time you are using IMPLANON. You may have more bleeding, less bleeding, or no bleeding. The time between periods may vary, and in between periods you may have spotting. Other common side effects reported in women using IMPLANON during clinical trials include: headache; vaginitis; weight gain; acne; breast pain; viral infections such as colds, sore throats, sinus infections, or flu-like symptoms; stomach pain; painful periods; mood swings; nervousness or depression; back pain; nausea; dizziness; pain; and pain at the site of insertion.

You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch, or call 1-800-FDA-1088.

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