Fertility Preservation Coverage: 2022 Outlook - PowerPoint Presentation

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Fertility Preservation Coverage: 2022 Outlook

Joyce Reinecke, JD

Executive Director,

Alliance for Fertility Preservation

October 25, 2021

Alliance for Fertility PreservationAbout Us A 501(c)(3). Professionals in oncology, reproductive endocrinology, research, bioethics, research, reproductive law. We believe that having cancer should not preclude parenthood.Our Mission To increase information, resources, and access to fertility preservation for cancer patients and the healthcare professionals who treat them.

Our VisionFertility preservation as a standard facet of cancer care so all patients receive the information, support, referrals and services they need to protect their individual reproductive and parenthood goals.Our Programs and ServicesFertility Scout®– Free, secure, online referral tool for patients and providersAdvocacy – Develop content and policy to support increased access to FPAwareness & Education – Provide online information and resources for patients and professionals

Patient Support – Patient stories, IA Mentor program, assistance with appeals

Successful FP Legislation (2017-19)

STATE

YEAR

BILL

STRUCTURE

GROUPS COVERED

LIVES

LIMITATIONS

COVERAGE SPECIFICS

CT2017HB7124Changed definition of InfertilityIndividual and group plans651,134Cycle limits; religious exemptionChanged statutory definition of “infertility” to “medically necessary”RI2017S 0821A & H 6170AAmended IVF mandate. Added FP coverageIndividual and group plans241,582Age limits (25-40); unclear whether applies to FPStandard FP services if necessary medical treatment may cause iatrogenic infertilityMD2018SB271 & HB908Amended IVF Mandate. Added FP coverageLarge groups only926,446No embryos; religious exemptionStandard FP services if necessary medical treatment may cause iatrogenic infertilityDE2018SB139New mandate for Infertility including IVF+FP No state employees or Medicaid 120,4386 cycles; religious exemption; retrieve by 45Coverage for specific treatments, inc. IVF & sperm, egg/embryo cryo. No exper. treatments IL2018HB2617New FP coverage not linked to infertility mandateBroad coverage inclu. state employees and Medicaid 5,303,325ACA mandate clause re: exceeding EHBStandard FP services if necessary medical treatment may cause iatrogenic infertilityNY2019S719/A2817*budgetAmend Infertility mandate to include IVF. Add FP coverageIVF: Large groups onlyFP: Ind., all group plans4,700,0003 cycles of IVF; FP TBDCoverage added through State Budget process. IVF + FP coverage.NH2019SB 279New mandate for Infertility including IVF+FP All “health carriers” (insurers, HMOs, etc.)208,515Limits can’t be “arbitrary”Standard FP services for eggs, embryos, sperm, and “material.” Storage through policy term.CA2019SB 600Clarifies existing coverage for FP All managed care plans; HMOs, some PPOs16,900,000TBD – Regs pendingCodifies regulator’s view that medically-necessary FP is a “basic healthcare service"NJ2020S2133FP coverageAll group plans 50+; state & school employees1,179,000No storageStandard FP services if necessary medical treatment may cause iatrogenic infertilityCO2020HB20-1158Infertility diagnosis and treatment, incl. IVF + FP All individual and group health plans1,196,0003 cycles of IVF; ACA clause; religious exemptionIF dx & treatment; FP for “condition” or medical treatment creating a risk of infertilityUT2021HB 192Directed Medicaid to create waiver for FP coverageMedicaid405,590Cancer onlyStandard FP services when needed cancer treatment causes substantial risk of infertility

Successful Legislation Fertility Preservation 2017-2021

31+ M

Lives Covered

!

Legislative Summary2017-to DATE

11 States Have Enacted FP Coverage:

California New Hampshire*

Connecticut New Jersey

Colorado* New York*

Delaware* Rhode Island

Illinois Utah**

Maryland

*Also includes IVF coverage**Medicaid only31+ MLives Covered!

Federal CoverageFederal Coverages:1. Office of Personnel Management (OPM) -announced coverage 2/17/21

-coverage starts Jan 20222. Veterans Administration-Directive 13323. TRICARE-Limited, supplemental coverage

Role of InsuranceExpand AccessAlleviate financial burden on patientsProtect fundamental life activity – reproductionFacilitate robust discussions between providers and patients about optionsLegitimize fertility preservation services as appropriate

Expedite & systematize processes for information and referralAddress current socioeconomic and gender access disparitiesMeet the Standard of Care

Principles of CoverageAll patients have the right to be fully informed about the possible effects of their medical treatment on their reproductive system and their ability to have children in the future.

They also deserve to be told of their options for preserving and protecting their ability to have genetic offspring and/or become a parent in the future, and to be referred to a fertility specialist for a thorough consultation. Fertility preservation options are only true options if patients can access them. Without insurance coverage for medically necessary fertility preservation treatments, many patients simply cannot afford sperm, egg, embryo, or tissue banking, especially in the midst of urgent, distressing, and often, costly, life-saving medical treatment.

“Model” coverageGoal: Coverage of standard fertility preservation procedures for patients who are at risk of iatrogenic infertility or sterility due to medically necessary treatments for serious or life-threatening illness.

Policy:Distinguish from “infertility” treatment coverageEstablish as part of comprehensive cancer careParallel to other side effects, WCHRA

Scope:Standard procedures as per ASCO, ASRMNot limited to cancerConsultations, evaluations, procedures, laboratory tests, medications, and storageNo arbitrary or discriminatory limits (age, prognosis, etc.)Medical necessity of procedures determined by physician All insurers

Looking AheadCoalition Building

Strategic Planning2021 wrap-up (states still pending)Annual review & goal settingFinalize 2022 target states

Explore federal coverage:Possible Federal legislationCon’t FEHBP implementationMedicaid Task ForceOutreach to AdministrationIncrease media, patient stories

2022 Priorities

State

TierDescription

Notes

Massachusetts

1

FP

2021 – positive report from CHIA – pending

Utah

1FPNew bill w/ expanded coverage; Planning call 10/27Washington1IVF+FPWaiting on final report from Sunrise cmteOregon1IVF+FPNew bill from health cmte going forwardVirginia1IVF+FPWaiting on HIRC; pending electionCalifornia2IVF onlyDecember briefing/hearingHawaii2FPGoal: trigger new auditor’s reportPennsylvania2IVF+FP (or FP)Dem caucus Wisconsin2IVF+FPBill being filed/announced Nov. 1Maine2IVF+FPWaiting on fiscal reportPossible: NC, TN (IVF+FP); MI, MO (FP only)

Thank you!

joyce@allianceforfertilitypreservation.org