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Improving Implementation of Fertility Preservation Benefit Mandates.

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State mandates for fertility preservation (FP) benefits face barriers like insurer interactions and patient knowledge gaps. Dedicated financial counselors and clear benefit definitions facilitate access to FP services for cancer patients.

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Area of Science:

  • Oncology
  • Reproductive Medicine
  • Health Policy

Background:

  • Over 90,000 adolescents and young adults annually face cancer treatments that risk future fertility.
  • Fertility preservation (FP) services (egg, embryo, sperm freezing) are crucial but often underutilized due to cost and access issues.
  • Despite 18 states and DC mandating insurance coverage for FP, patient and clinician access remains challenging.

Purpose of the Study:

  • To systematically identify determinants influencing the implementation of FP benefit mandates in fertility and oncology clinics.
  • To inform the development of interventions and future public policy for improved FP access.
  • To understand barriers and facilitators affecting FP benefit implementation at clinic and patient levels.

Main Methods:

  • A mixed-methods study involving 48 participants from 24 oncology/fertility clinics and 2 fertility pharmacies in 3 diverse states (CA, IL, NY).
  • Utilized interviews and surveys based on the Exploration, Preparation, Implementation, Sustainment (EPIS) framework.
  • Data collection occurred from July 2020 to November 2023, with analysis from September 2022 to June 2024.

Main Results:

  • Key barriers included time-consuming clinic-insurer interactions, patients' lack of benefit knowledge, and inconsistent insurance coverage.
  • Top facilitators were dedicated financial counselors for benefit verification, clearly defined FP benefits in handbooks, and existing IVF insurance.
  • Interviews (n=48) and surveys (n=17) identified determinants crucial for successful FP benefit mandate implementation.

Conclusions:

  • Systematically identified barriers and facilitators can guide improvements in FP benefit mandate implementation.
  • Findings support policy and intervention development to enhance timely access to FP insurance benefits for patients and clinics.
  • Results provide a foundation for future legislative and regulatory efforts aimed at increasing FP access.