FAFTA Report 2019

REPORT: COST OF MAKING ACCESS
TO IVF AVAILABLE TO NEW YORKERS

THROUGH INSURANCE IS MINIMAL
February 2019
Issue #: [Date] Dolor Sit Amet
SUMMARY OF FINDINGS
For women and families in New York that suffer from infertility, the positive news is
that technological advancements in in vitro fertilization (IVF) treatments are making the
once unattainable concept of biological families for many individuals a new reality.
Unfortunately, private insurance companies in the state are not required to offer IVF
treatments to their customers.
In 2018, the Coalition to Help Families Struggling with Infertility (CHFSI) produced a
study to determine the insurance cost per customer if the Fair Access To Fertility
Treatment (FAFTA) were signed into law. Using insurance data, fertility statistics and
publicly available data from New York and other states, we determined that for $6.60
per insured member per year ($0.55 per month), IVF coverage could be offered to every
New Yorker with a private insurance plan (for a full methodology, see the final page of
this report).
There are 42.4 million women ages 25-44, of which 6.1 million struggle with infertility
and 1.45 million seek the help of a fertility specialist. Of these women, 110,000 (or 1.8%)
choose to receive IVF treatment. Even with expanded insurance coverage nationally,
IVF utilization would only increase by 50,000 people.
Currently, five out of 1,000 women currently do IVF in New York State. With
updated insurance laws that require coverage for IVF, the data indicate this figure would
increase to six out of 1,000.
Building on the methodological framework of our initial study, we have found that
3,000 additional women in New York would likely access IVF treatment in the first
year following FAFTA’s enactment. These findings show that the cost of requiring
insurance companies in New York to cover fertility treatments like IVF would be
minimal and evenly spread throughout the existing health care system.
2
ABOUT CHFSI
The Coalition to Help Families Struggling with Infertility represents a broad range
of groups and individuals from across New York with a collective goal of urging
the members of the New York State Legislature updates laws, so all health
insurance in the state covers the latest and most effective fertility treatments like in
vitro fertilization (IVF) and fertility preservation. This would help thousands of
New Yorkers have the baby of their dreams, since the out of pockets costs
associated with fertility treatments make it impossible for many people to access
them.
RESOURCES
The Coalition to Help Families Struggling with Infertility is comprised of

leading experts in the field of infertility and reproductive health and is
available for interviews. We also can connect you with patients struggling to
build their family who can share their experience with insurance coverage or
lack of coverage and the added toll that takes on their journey.
3
RESULTS & METHODOLOGY
The study assumes there will be approximately 3,000 patients who will seek the
treatment. We arrived at this number using a combination of additional (1) cancer
patients with treatments that could lead to sterility and (2) infertile women who
need to see a specialist, that have fully insured health insurance policies and will
elect to utilize IVF based on Fertility Dynamics data in states with similar fertility
coverage laws.
The study further assumes that insurance will pay approximately $20,600 per
patient. This is based on total cost, including drugs, of $13,500 for 1 cycle by cancer
patients and $5,500-$13,500 per cycle for 1-5 cycles by others. Use and cost pattern
derived from experience in states with similar fertility insurance laws and 10%
lower than currently in New York due to expected payer negotiation. We assume
20% paid directly by patients in form of co-pays and deductibles.
We assume reducing multiple births will save $10 million. We base this on reduction
in multiple births related to IVF in states with similar fertility coverage laws [CDC
2015] and IUI derived from patient research [Fertility Dynamics] applied to $92,850
average additional cost per multiple birth [Lemos AJOG 2013].
We assume 4.5 million New Yorkers are fully insured. We based this on New York
population of 19.7 million x 57% with health insurance that is not Medicaid or
Medicare x 40% nationwide with fully insured health insurance policies [KFF Benefit
Surveys 2016-17].
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REPORT: COST OF MAKING ACCESS

TO IVF AVAILABLE TO NEW YORKERS

The Coalition to Help Families Struggling with Infertility is comprised of

RESULTS & METHODOLOGY

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