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Three Ways to Help Your Members Avoid Interrupted Fertility Treatment

A well-designed fertility benefit helps members stay on treatment, reducing wasted dollars
How to Build a Fertility Benefit

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.

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FamilyPath
FamilyPath has expanded benefit offerings across family-planning, fertility, pregnancy and postpartum care for employers and health plans. Evernorth is committed to addressing disparities in this category of health benefits and has designed an end-to-end, inclusive benefit in family-planning care for members across both in-house capabilities and new partnership solutions.

1 Freedom Fertility Pharmacy operations data, March, 2022.