Impact of Texas House Bill 1649 on Fertility Preservation Utilization and Awareness

To evaluate the impact of Texas House Bill 1649 (HB 1649) on access to fertility preservation (FP) services among oncology patients, with a focus on insurance coverage, FP utilization, and disparities by gender and race.

This retrospective cohort study was conducted at a National Cancer Institute-designated Comprehensive Cancer Center in Texas. Oncology patients undergoing FP consultations between January 1, 2024, and December 31, 2024, were included. The primary outcome was the proportion of diagnosed patients with cancer eligible for FP insurance coverage under HB 1649. Secondary outcomes included FP utilization, patient awareness of insurance benefits, and social disparities in FP.

Of 580 reproductive-aged patients with cancer evaluated for FP, 405 Texas residents (307 females, 98 males; mean age 31 years) were included. Among these, 242 (59.8%) had FP coverage under HB 1649 and 163 (40.2%) did not, most commonly due to out-of-state, government-funded, or military insurance. Demographic characteristics, including gender, age, and ethnicity, were similar between groups. FP interest was high in both groups (76.5% vs. 74.2%); however, coverage was associated with greater benefit awareness (9.9% vs. 1.2%, p < 0.001) and higher FP completion (33.1% vs. 23.3%, p = 0.045). Multivariable analysis showed that interest in FP, male sex, and insurance coverage were positive predictors of FP completion, while Black race was associated with lower completion.

HB 1649 has improved FP access by reducing financial barriers; however, gender and racial disparities in FP utilization and low awareness of insurance benefits persist, highlighting the need for targeted interventions.