New York State Expands IVF Coverage

For many struggling to start a family, the impact of an infertility diagnosis is painful, but the lack of access to treatment makes the impact even more difficult.  Infertility diagnostic testing and treatment usually requires the use of expensive technology and patients facing infertility can quickly run out of options for financing their journey to parenthood.  


For patients who have recently been diagnosed with cancer or another condition that will likely cause them to be infertile in the future, the financial burden of preserving their fertility can be overwhelming on top of their other medical bills which are mounting quickly.  For single patients or same sex couples, lack of financial means to access the technology that they need to conceive significantly inhibits their ability to start a family.  Efforts to bring down the cost by providers were the only hope for these patients, but as the technology itself is very costly, these efforts can only go so far.  


Many people begin their journey anxious, but hopeful that they will conceive early on in their treatment.  When less invasive treatments fail and it becomes necessary to use higher technology, patients hope that they could find the funding to continue with more expensive treatments.  While the vast majority of patients attempting to conceive do have some type of insurance coverage, they often find that their employer based coverage does not include infertility treatments.


An infertility diagnosis for male patients begins with bloodwork and semen analysis.  For female patients, diagnosis consists of bloodwork and imaging studies.  These tests alone can add up to thousands of dollars for a heterosexual couple who do not have insurance coverage.  Once infertility is diagnosed, most patients will begin treatment with intrauterine insemination.  These treatments include bloodwork, sonograms, medication, and culminate with semen preparation and insemination.  It takes expert staff working in the office and laboratory to coordinate and execute these treatments.  The success rates hover in the 10% range so most patients will need multiple treatment cycles to conceive one healthy pregnancy.  


When these treatments fail, or if either patients’ diagnosis is severe, in vitro fertilization is a more powerful treatment method, but it also comes with a much higher cost.  In vitro fertilization requires bloodwork, sonograms, expensive injectable medication, out-patient surgical removal of the eggs under anesthesia, semen preparation, insemination and culture of the eggs and sperm to create embryos which are then cultured and prepared for either cryopreservation or transfer to the uterus which is also done in the operating room.  This process requires a compliant operating room, recovery room, a highly regulated clean room filled with high power microscopes, heated biological safety cabinets, specialized incubators designed for human tissue culture, cryogenic storage tanks, a constant supply of liquid nitrogen, as well as highly educated and skilled scientists.  The costs for in vitro fertilization are therefore, much more expensive than less invasive technologies.  And the success rates hover around 30% per cycle so most patients will do more than one cycle before they are successful.


New York State has taken bold action to guarantee that patients have better insurance coverage for infertility treatment in 2020.  This will ensure that they can focus more on their journey to parenthood and less on trying to figure out how they will pay for it.  This mandate requires that insurance policies provide coverage for medically necessary fertility preservation.   If you or your loved ones ever experience a diagnosis of cancer or another disorder that will cause infertility in the future, coverage will be available to cryopreserve eggs and sperm before becoming infertile.  Further requirements require any employer with at least 100 employees to offer infertility coverage with their standard insurance plan offerings.  This means that many patients who previously had to find creative financing options to get the treatment they need, will now have the coverage available.


The mandate requires that these plans offer 3 treatment cycles including in vitro fertilization, frozen embryo transfer, medication and testing.  The mandate also prohibits an insurance company from discriminating against patients based on age, sex, sexual orientation, marital status, or gender identity.  Likewise, the definition of infertility has been updated under state law to be more inclusive of single women and same sex couples who previously had trouble meeting the definition which required 12 months of unprotected sexual intercourse.  This updated definition will mean that every family in New York State can follow their own path to parenthood whether that path leads to intrauterine insemination or in vitro fertilization.  For more information on how this mandate applies to you, speak to your benefits administrator.  For more information on the New York State mandate, on the Fair Access to Fertility Treatment Act, and infertility in general visit Resolve.org.
 

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