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 more than $14,000 for medications, appointments, and procedures that can no longer be utilized for completion of a cycle.
Patients discontinue treatment for a variety of reasons, e.g., their benefits may run out mid-cycle, the medications aren’t delivered on time, or they experience a lack of support. A well-designed plan addresses those issues and more by supporting members, offering a comprehensive benefit, and taking a cycle-based approach.
Members undergoing fertility treatment need support, including access to user-friendly, clearly written member materials, and behavioral and financial assistance.
- Clear Member Materials – Well-designed materials help patients understand their benefit and answer questions about providers and appointments. Providing members a dedicated support person throughout their treatment can reduce stress and confusion thanks to personalized guidance around scheduling, coverage, and education.
- Behavioral Support – Treatment for infertility can be extremely stressful, with one study finding that 87% of women undergoing fertility treatments experienced anxiety and 41% suffered from depression, which stresses the need for behavioral health resources like digital cognitive behavioral therapy.
- Financial Support – Managing infertility can also be expensive. Members who are able to pursue treatment without financial concerns tend to be more productive at work. In contrast, researchers have found that employees worrying about their finances lose approximately a month of productivity in a year.
Offer a comprehensive 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, a fertility-focused pharmacy, coordinated 1,400 same-day deliveries in 2019.
Overall, a comprehensive benefit leads to more cost-effective fertility decisions.
Take a cycle-based approach to benefit design
Patients in a well-designed fertility benefit receive treatment in cycles, and not per a maximum dollar amount. 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. A majority of patients may require multiple rounds of treatment to become pregnant, with the average chance of taking home a baby with each IVF cycle being 30%. Patients who 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. In fact, inadequate fertility coverage can lead to increased downstream costs of up to 40%. For example, patients transferring multiple embryos to increase chances of having a child through IVF generated more than $42,000 in additional costs, according to a report from Reproductive Medicine Associates of New Jersey―further emphasizing the need for a comprehensive, well-designed fertility benefit.
Learn more about FamilyPath and how to provide comprehensive, cycle-based fertility coverage for your members.