Improving Implementation of Fertility Preservation Benefit Mandates

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.