When designing a plan for fertility benefits, focus should be placed on encouraging patients to stay on course during treatment cycles. Discontinuation rates for fertility treatment are high―between 46%-58%, even for those with health insurance that covers fertility treatment. In addition to causing stress, frustration, and disappointment, each interrupted IVF cycle can cost anywhere between $12,000 and $25,000 for medications, appointments, and procedures that can no longer be utilized for completion of a cycle.
Patients discontinue treatment for a variety of reasons, like their benefits running out mid-cycle, medications not being delivered on time, or experiencing a lack of support. A well-designed plan addresses those and other issues by supporting members, offering a comprehensive benefit and taking a cycle-based approach.
Support Members
Members undergoing fertility treatment need support, including access to user-friendly, clearly written member materials and behavioral and financial assistance.
Offer a comprehensive fertility benefit
A well-designed fertility benefit is an important tool to help prevent patients from discontinuing treatment. A comprehensive benefit provides clinical expertise across both the medical benefit and pharmacy benefit and offers high-quality lab and provider networks.
In addition, a fertility-focused pharmacy can send patients all their medications in one package, and is equipped to provide emergency deliveries when needed for time-sensitive treatments. In fact, Freedom Fertility, an Evernorth fertility pharmacy, is said to have 50% of its orders ship within 24 hours.1
Overall, a comprehensive benefit leads to more cost-effective fertility decisions.
Take a fertility cycle-based approach to benefit design
Patients in a well-designed fertility benefit receive treatment in cycles. A cycle includes every step necessary for a round of treatment. This method allows treatments to adhere to the most up-to-date clinical guidelines.
Cycle management strategies are important for helping patients navigate multiple rounds of appropriate care within their benefits. With the average chance of taking home a baby with each IVF cycle being 30%, patients may try multiple rounds of treatment to become pregnant. Patients who hit a dollar amount or run out of coverage mid-cycle are at risk of discontinuing treatment, leading to wasted dollars.
A patient who discontinues treatment can feel frustrated and let down by their employer’s benefit plan. Studies show the top driver of employee satisfaction with a plan is its comprehensiveness. For the employer, a missed opportunity equates to wasted plan dollars and increased costs of subsequent treatment attempts.
Additionally, inadequate fertility coverage can lead to increased downstream costs stemming from hospital and high-risk maternity-related costs, which further emphasizes the need for a comprehensive, well-designed fertility benefit.
Originally published on 10/7/20 and updated on 4/12/23.