STUDY ON COST TO MAKE IVF TREATMENT

AVAILABLE TO NY RESIDENTS THROUGH

INSURANCE COMPANIES
INTRODUCTION

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 companies 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 other publicly available 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).

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 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.

Methodology

The study assumes there will be 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].

ADDITIONAL FAQ

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.

The effect of utilization on cost:

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.