Health Care Reform and Fertility Drug Coverage

Couples facing infertility often have very limited health insurance options. Most insurance plans simply do not cover infertility treatments. Fifteen states mandate coverage at some level, but even if you work in one of the covered states there are many loopholes. With the recently passed Health Care Reform Act, perhaps there is some relief in sight for couples looking for coverage.
In an earlier article we looked to see if the Health Care Reform Act directly addressed infertility coverage in any way. Looking at the Senate version of the bill widely available on the internet, and using the word search feature found in Adobe Valley Medical Center Billing documents we were able to find absolutely no references for infertility, IVF, ART, and a variety of other terms significant for couples trying to conceive. It appears that the bill does not directly address infertility health insurance coverage.
So we ask ourselves; is there any indirect assistance? Fertility drugs such as Bravelle, Clomid, Follistim, etc., can make up a significant component to the Unique Jobs for Pharmacists total cost of infertility. Health insurance plans that cover the cost of these drugs makes a big difference in the affordability of infertility treatments.
One of the key components of the bill addresses prescription drug coverage – an important feature of any health insurance plan. So let’s see how many mentions there might be for “prescription”: the term “prescription” is mentioned 136 times. Perhaps there is a glimmer of hope.
Of the 136 mentions of prescriptions, every single mention is associated with Medicare Part D: the prescription drug plan associated with the government run health plan for seniors. Medicare is our country’s health insurance program for people over the age of 65. Most couples trying to conceive are far too young to qualify for this coverage, so most of the mentions won’t apply.
But Medicare also covers people who have disabilities, permanent kidney failure, or amyotrophic lateral sclerosis (Lou Gehrig’s disease). Younger people in the latter two categories may qualify for Medicare, but may not be healthy enough to have children. This leaves only a very narrow segment of couples trying to conceive who might be impacted by the Part D legislation. We can conclude that this portion of the legislation is of little help.
So it seems that there is nothing concrete in the bill relating to fertility drugs. But we will keep looking, and reporting back to you want we find. In the meantime, remember that many of the bills components do not go fully into effect until 2014. For those looking for coverage right now, consider that supplemental health insurance can help you recoup some of your infertility treatment costs when you deliver your happy healthy baby.