REPORT: COST TO MAKE IVF

TREATMENT AVAILABLE TO NEW

YORKERS THROUGH INSURANCE

June 2018
Issue #: [Date] Dolor Sit Amet

SUMMARY OF FINDINGS

For women and families in New York that suffer from infertility, the good 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, the bad news is that private insurance policies in the
state are not required to offer IVF treatments to their customers.

The Coalition to Help Families Struggling with Infertility (CHFSI) conducted this
study to determine how much, on average, making this treatment available would
cost insurers per customer.

The results were astonishing.

Using insurance data, fertility statistics and publicly available Medicare and
Medicaid data from New York and other states, we have 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).

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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 to update the law, 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 are
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.

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RESULTS & METHODOLOGY

The study assumes there will be an increase of approximately 1,900 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 NY 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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ADDITIONAL
ADDITIONAL FAQ
FAQSS

How does the average cost of IVF paid by insurers come to $20,600 when the bill allows
for spending up to $50,000?

There are several calculations inherent in arriving at this number.

First, note that the cost per stimulation cycle is assumed to be $13,500. This is lower than
the current average because, 1) it is assumed that payers will negotiate lower fees (and we
have chosen a conservative estimate of just a 10% reduction, which could be higher); and
2) it is assumed that patients will pay 20% of total costs in the form of co-pays and
deductibles once this benefit is covered by insurance.

What is the effect of other individual variations?

Cancer patients will use only one stimulation cycle at a cost of $13,500, bringing the
average cost down. Some number of IVF patients will get pregnant on the first try, and will
not go through a second or third IVF, again at a cost of $13,500.

Some number of patients will fail to conceive on the first try, but will be able to do so on a
second try with frozen embryos, so the cost here would be $13,500 plus $5,500 for a total
of $19,000 – still below the average total cost paid by insurers.

Only when those patients who fail on a first try AND a second try using frozen embryos,
and then try a second fresh or a second frozen cycle, will the cost begin to exceed the
average.

Remember too, that patients who fail once or twice begin to drop out at higher rates, thus
reducing the number of those trying a third or more times. The bottom line is that
between successful pregnancies and drop-outs from failed attempts, the average cost per
patient will be inherently limited, even below that of the dollar limit in the bill.

This fact has been borne out in Maryland (with a $100,000 spending cap) where the
average spend per patient is between $25,000 - $30,000.

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Issue #: [Date] Dolor Sit Amet