MORE COVERAGE, MORE CARE: INCREASED FERTILITY PRESERVATION VOLUME BEFORE AND AFTER STATEWIDE INSURANCE MANDATES

Abstract

As of January 1, 2019, Illinois state law mandates that insurers cover fertility preservation (FP) for patients facing iatrogenic infertility. As of April 2021, 10 states have enacted similar mandates, but only Illinois extended coverage to Medicaid recipients. Few studies have examined the impact of these laws on FP care. Our study aimed to examine FP care at a single large academic medical center in Illinois before and after the enactment of law mandating FP coverage. DESIGN: Retrospective cross-sectional study We analyzed all medically indicated FP consultations and completed cycles performed at our fertility center between January 1, 2017 and December 31, 2020, representing the two years before and after enactment of the insurance mandate. Data were analyzed using Mann-Whitney-U, student’s T test and Fisher’s exact test where indicated (p<0.05). 436 FP consultations were performed, and 282 patients completed 319 cycles at our center over the study period. Minimal change in patient and cycle volume was seen in the first year after the insurance mandate took effect, but there was a sharp increase in consult, patient, and cycle volume in 2020 (Table). More patients with Medicaid insurance were seen after enactment of the mandate (11 vs 28), and more of these completed FP cycles (3 vs 16, p=0.003). Among patients who completed cycles pre- and post-mandate, there was no difference in race or ethnicity (9.3% vs 12.0% identified as Black, and 8.5% vs 9.2% identified as Hispanic or Latinx). Clinical characteristics pre- and post-mandate were similar when comparing age (29.6 vs 29.1, p>0.05) and medical diagnosis, with the most common diagnoses being breast cancer (32% vs 30%, p>0.05) and hematologic malignancies (19% vs 18%, p>0.05). AMH was higher (2.70 vs 3.54, p=0.02) and more oocytes were retrieved per cycle (16±10 vs 20±12, p=0.02) in patients completing FP post-mandate. There was no difference in rates of oocyte cryopreservation and embryo cryopreservation pre- (65%, 36%) and post- mandate (69%, 31%) (p>0.05). Our data from a large academic medical center suggest Illinois legislation may lead to increased FP consultation and cycle volumes and expanded access to FP for publicly insured patients. Further research is needed to examine the how implementation of insurance mandates can maximize access and affordability for patients.