Should health plans cover fertility preservation for cancer patients?

Young adults undergoing toxic therapies for cancer have highly effective options to preserve fertility. But the great cost – easily $15,000 or more for a woman – puts the option out of the reach of many. A proposed Oregon law would require health insurance to pay for some fertility preservation services when medical treatment is likely to damage fertility.

“It’s not something someone can plan ahead for and save for; these patients need to start their therapy,” OHSU’s Brandon Hayes-Lattin, M.D., told lawmakers at a Mar. 11 hearing on Senate Bill 911. Hayes-Lattin, a professor in the School of Medicine and director of the Adolescent and Young Adult Oncology Program in the Knight Cancer Institute, was part of a contingent from OHSU testifying in support of bill.

Image: Wellcome Collection/Heather Spears [CC BY]“We often encounter young adults who will actually delay their therapy in order to start a family, or even forego therapy altogether,” Hayes-Lattin said. “There are well-documented examples in breast cancer of women foregoing adjuvant chemotherapy or hormone therapy in order to preserve fertility when they didn’t have access to these techniques.”

Danielle Cooper was 28 years old when she was diagnosed with breast cancer in 2016. She was given an estimated cost of $35,000 for egg retrieval and storage that would be necessary for her to have a second child. She and her husband couldn’t afford it.

Cancer survivors Danielle Cooper, Corrin Parks and Kara Skaflestad shared personal testimony in support of Senate Bill 911 at a hearing in Salem. (OHSU/Kate Rigall)

“Raising the funds to pay for this treatment would have taken time I did not have due to the aggressive nature of my cancer,” she testified.

The S.B. 911 mandate would apply to state-regulated health benefit plans, the state medical assistance program, the Public Employees’ Benefit Board and Oregon Educators Benefit Board. They would have to pay for standard fertility preservation services for covered individuals whose medical treatment is likely to result in iatrogenic infertility, that is, an impairment of fertility caused by surgery, radiation, chemotherapy or other medical treatment affecting reproductive organs or processes. The bill defines standard fertility preservation as procedures to preserve fertility and store for one year an individual’s eggs or sperm.

Health insurance company representatives at the hearing said the industry has a neutral position on the bill. But they told lawmakers to be mindful of the effect on the cost of health insurance when plans are mandated to cover more and more services.

“I hope we can continue to look at these collectively and make decisions understanding what the cost is going to be to everyone,” said Elise Brown, a lobbyist for America’s Health Insurance Plans.

OHSU government relations staff estimate that about 150 Oregonians each year would seek coverage for fertility preservation. (Only about 5 percent of people diagnosed with cancer are in their reproductive years.)

study of the cost of Maryland’s state’s fertility preservation mandate estimated that it would increase premiums by about 10 to 24 cents per member, per month. (The study assumed that 1,200 Maryland residents age 15 to 39 are likely to require a fertility-damaging medical treatment each year, and that a quarter to third of them are likely to pursue fertility preservation.)

At least five states have passed laws similar to S.B. 911 requiring coverage of fertility preservation: Connecticut, Delaware, Illinois, Maryland and Rhode Island.