In 1985, Maryland passed innovative legislation that required health insurance companies to cover the costs of fertility treatments. Since that time 15 U.S. states followed suit and now require insurance companies to cover the costs of egg retrieval, in vitro fertilization, and other infertility treatments for people who have trouble conceiving children. A new paper in the Journal of Law, Medicine, and Ethics by Oncofertility Consortium researchers discusses the barriers to expanding existing infertility mandates to include preventative fertility preservation for cancer patients.
The paper, “Insuring Against Infertility: Expanding State Infertility Mandates to Include Fertility Preservation Technology for Cancer Patients,” describes why cancer patients do not currently fall within the scope of existing mandates. These laws require that patients be diagnosed with infertility before receiving coverage. Authors Daniel Basco, Lisa Campo-Engelstein, and Sarah Rodriguez explain that while different legal and health organizations have their own definitions of infertility, most require that individuals engage in one year of unprotected intercourse without achieving a pregnancy. Since most cancer patients do not fall under that definition, state mandates do not cover fertility preservation.
Fertility preservation mandates may be necessary because patients interested in fertility preservation prior to beginning chemotherapy or radiation may not be able to afford the treatments. Since no health insurance company uniformly covers fertility preservation, cancer patients may need to appeal to their companies in the short time between diagnosis and treatment. Patients may not know how to navigate this complex process, especially while simultaneously dealing with a recent cancer diagnosis, and thus lose the ability to have biological children.
Basco, Campo-Engelstein, and Rodriguez also examine how current infertility mandates could be altered to incorporate the needs of young cancer patients who would like to preserve their fertility. Using the Massachusetts mandate as a model, they discuss the potential legislative routes to providing fertility preservation coverage to cancer patients. Cancer organizations may use these routes to advocate that health insurance companies cover fertility preservation at the state and federal level. In the meantime, patients should utilize their local medical advocates or the national FERTLINE’s patient navigators, who have had success increasing fertility preservation coverage for young cancer patients.