Association of Fertility Preservation Benefit Mandates With Sperm Bank Network Adequacy: A Mixed-Methods Study

Area of Science:

• Oncology
• Reproductive Medicine
• Health Policy

Background:

• Iatrogenic infertility resulting from cancer treatments necessitates fertility preservation.
• State mandates aim to improve insurance coverage for fertility preservation services.
• Barriers to clinic acceptance of insurance for these services remain unclear.

Purpose of the Study:

• To qualitatively explore barriers to clinic acceptance of insurance for sperm banking.
• To quantitatively assess the association between fertility benefit mandates and clinic insurance acceptance.

Main Methods:

• In-depth interviews with sperm bank staff in three mandate states.
• A US-wide "secret shopper" study of fertility clinics evaluating insurance acceptance for sperm banking.
• Assessment of cash costs for sperm freezing services.

Main Results:

• Four themes emerged: coverage gaps, insurance navigation burdens, prior authorization delays, and educational needs.
• 56% of surveyed clinics offered sperm banking; only 36.9% accepted insurance.
• Clinics in mandate states were more likely to accept insurance (61.0% vs. 27.8%).

Conclusions:

• Fertility preservation mandate effectiveness is hindered by insurer and clinic-level barriers.
• Improved access to fertility preservation benefits requires strategies to overcome these barriers.
• Male cancer patients need enhanced access to fertility preservation services.