POSITION STATEMENT: INSURANCE COVERAGE FOR IATROGENIC INFERTILITY
Annually, more than 130,000 patients are diagnosed with cancer during their reproductive years (under 45 years). Fortunately, the 5-year survival rate for these patients is 79 percent. However, in order to survive their disease, cancer patients must undergo medically necessary treatments that can directly or indirectly cause iatrogenic infertility, including surgery, radiation, chemotherapy and targeted and hormonal therapies.
Iatrogenesis refers to any adverse condition in a patient resulting from medical treatment. Infertility caused by cancer treatments is iatrogenic—an unintended consequence of treatment akin to other medical side effects of cancer treatment, such as nausea, fatigue, hair loss and amputation.
The financial costs of cancer can be very high and difficult to manage. Even when traditional insurance coverage of infertility exists, cancer patients are often denied coverage because they do not meet the strict criteria of the definition of infertility.
Accordingly, LIVESTRONG is advocating for cancer coverage that includes coverage for fertility preservation to remedy iatrogenic infertility, reduce patient distress, enable better treatment decision-making and increase corporate goodwill.
Case for Coverage
- Iatrogenic Condition
In order to survive their disease, cancer patients must undergo medically necessary treatments that can directly or indirectly cause iatrogenic infertility. Cancer benefits typically include coverage for the remedy of iatrogenic conditions, including procedures that are otherwise considered elective.
- Right to Parity
The concept of do no harm and the medical community’s responsibility to mitigate iatrogenic harms is well established in medical ethics, federal laws and current insurance practices.
- Benefit Already Exists
Fertility preservation is already covered as a part of cancer care with the exception of two of the most successful treatment choices: sperm and embryo cryopreservation.
- Low Usage, Low Cost, Positive Returns
The at-risk population is small, the cost per member per month is low and there is potential for significant positive cost offsets.
- Avoids Risk of Adverse Selection
Rapid initiation timelines for cancer treatments are such that there is a very low risk of patients switching policies to take advantage of this benefit.
As national conversation for health insurance coverage for fertility preservation develops, LIVESTRONG and the Cancer Legal Resource Center joined together to develop a position statement outlining standards for health insurance coverage to address the crisis of iatrogenic infertility at the time of a cancer diagnosis.
It is the position of LIVESTRONG and the Cancer Legal Resource Center that:
- Consistent with the standard of care recommendations outlined by the American Society for Clinical Oncology, all cancer patients should be informed of their risks of iatrogenic infertility as early in cancer treatment planning as possible
- All health insurance providers should provide coverage for all standard fertility preservation treatments when necessary medical
- treatments may directly or indirectly cause iatrogenic infertility
- Any risk of iatrogenic infertility should be determined by the licensed physician prescribing and/or performing the treatment posing harm to the patient’s fertility (e.g., oncologist
- Health insurance coverage for standard fertility preservation services for iatrogenic infertility should be dependent on a diagnosis of a medical condition requiring treatment that may cause infertility, not a diagnosis of infertility
- All coverage language should be written so that when experimental fertility preservation treatments become standard practice as determined by appropriate professional societies, such as the American Society for Reproductive Medicine or the American Society for Clinical Oncology, they, too, become covered
- Patients should be charged the same copayment, coinsurance and deductible rates as other comparable hospital, medical, pharmaceutical or surgical services covered under the policy or heath plan service contract for standard fertility preservation services
- Standard fertility preservation services shall be subject to the same annual and lifetime limits as other comparable hospitals