Obtaining insurance coverage for fertility preservation is rare among patients treated for cancer, and few states currently have an existing mandate for obtaining coverage, according to an article published in The New England Journal of Medicine.

According to the investigators, costs associated with fertility preservation represent one of the most substantial barriers to care for female cancer survivors. In some cases, fertility preservation treatment is required immediately after cancer is diagnosed, and many patients have little to no time to appeal to their insurance providers for coverage.

Only 15 states mandate that insurers offer some form of coverage for infertility treatment; however, the definition of “infertility” in these mandates does not directly apply to fertility preservation. Additionally, insurers receive no incentives to provide for the costs of fertility preservation in patients who become sterile following cancer treatment.

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The investigators state that several obstacles for equal access to fertility preservation and care currently exist. For example, current legislation is applicable only to private insurance companies and not to government-based payers.

The investigators also point out that states should understand the “potential resistance related to [Affordable Care Act] provisions intended to discourage states from passing mandates that exceed the essential health benefits requirements.” Costs associated with mandates passed after 2011 must be covered by the states instead of by insurers. Revision of mandates unrelated to infertility may represent an alternative strategy in states without a current infertility mandate.

Additionally, coverage for infertility treatments among men is limited. “We hope that as more states enact similar legislation,” said the investigators, “all insurers…will consider making their policies more inclusive.”

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Cardozo ER, Huber WJ, Stuckey AR, Alvero RJ. Mandating coverage for fertility preservation – a step in the right direction. N Engl J Med. 2017;377(17):1607-1609.