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Written Lesson

Overview of Costs

The degree to which cancer patients must pay out of pocket (rather than have it subsidized) for fertility preservation varies dramatically by region. In 2016, experts from 43 countries weighed in on the costs patients accrued and reported a range from practically no cost(e.g. in France, Netherlands, Spain) to substantially high expenses (e.g. in South Korea, United States). Below is data from the survey, and as always, it’s important to consult with your local experts and authorities (as well as a person who may oversee your benefit from an employer) on what expenses you may be asked to cover, which can depend upon your cancer diagnosis, age, and other factors.

Within the United States, roughly 10–15 states have enacted legislation to mitigate the cost of fertility preservation for cancer-related purposes. However, the laws vary dramatically as it pertains to who qualifies for coverage and which aspects of the process are covered.

In countries, like the United States, the total costs can amount to $10,000–$20,000 per “cycle.” Some insurance plans will cover parts (or the entirety) of the cost, depending upon how the policy is written. Below, we include a sample line item set of a cycle’s expenses in the United States and how some costs can be mitigated.

In many countries, including the United States, patients may be able to reduce aspects of the cost in a few ways.

Clinic and Laboratory Costs

First, some clinics (e.g. those associated with Livestrong) are prepared to reduce their fees by roughly 25% which can equate to $1,000–$3,000 in savings. Even clinics not in the program are often open to providing at least a 10% discount on their services when a patient explains their need for treatment is cancer-related.

Drug Costs

Second, the vast majority of fertility drug medication is made by a handful of pharmaceutical businesses (e.g. EMD Serono/Merck KGA, Ferring, Organon) each of whom provide discounts for patients with a financial hardship in general and for cancer patients specifically (region dependent.)

Freezing Eggs or Embryos, ICSI, and PGT-A

As we’ll discuss in a later lesson, patients may have the choice to freeze either eggs or, if sperm is available, embryos. Each has its trade-offs, but from a financial perspective, freezing eggs tends to be cheaper up front (as the costs to fertilize eggs and grow them to embryos is not a factor for the moment.)

Should one decide to freeze embryos, there are decisions patients and doctors can make that will influence costs. First, while many patients are told they need to fertilize their eggs using ICSI (e.g. $5,000 cost in the U.S.), only for very specific patient groups (see here) has the technique been shown to improve the odds of a live birth. Similarly, while many patients are encouraged to genetically test their embryos using PGT-A (also roughly $5,000 of additional cost in the U.S.), the odds the test meaningfully lowers the odds of miscarriage, needless transfers, or challenges to the offspring are case-dependent (see here).

Storage Costs

In some countries patients have the opportunity to have their frozen eggs or embryos kept at a third party, non-clinic associated storage facility. To the positive, these facilities often charge around half of what clinics charge to keep eggs and embryos frozen onsite. To the negative, shipping eggs or embryos may introduce some hard-to-quantify elements of risk and characterizing a third party’s capabilities may be difficult. Presuming a storage period of 10 years (will vary depending upon the age at which someone freezes), transferring to a third-party facility may amount to savings of $2,500–$5,000.

Tax Savings

In some countries where patients pay for treatment, the amount paid for treatment can be deducted from one’s income, and thus, the tax basis (and ultimately the taxes paid) may be lower. In these cases, it’s critical patients keep detailed records and receipts of the expenses they accrue and consult a local tax expert.

Working Through Your Employer

Many patients may have their insurance through an employer. Some employers pay for fertility treatment and often (but not always) the mention can be found (sometimes buried) in a “summary of benefits” (SOB). For instance, employees for the State of North Dakota in the United States can find their details on page seven of their nine page policy.

It's also a good idea to refer to the plan handbook, also called the "Evidence of Coverage" (EOC), and use the keyboard shortcut "Control + F" to search for the term 'fertility'. However, note that the information may not always be available in either the SOB or EOC. Therefore, it's important to reach out to member services and let them know about your cancer diagnosis and the need for fertility preservation. It can be helpful to have the diagnosis code for cancer and the procedure codes for fertility preservation services ready when you make the call. Your healthcare provider or hospital may provide you with a summary that includes diagnosis or ICD codes, which are usually listed under "diagnosis" or "Dx". Additionally, Explanation of Benefits (EOB) statements from your insurance company, Medicare, or another payer might also include ICD codes, but it's a good idea to confirm this information with your healthcare provider for accuracy.

Some plans will cover “fertility preservation” for cancer patients, but often the way the policy is written can be ambiguous. In the case of employees at The University of Michigan (see the example below), the wording doesn’t explicitly mention “cancer” or “oncology” but the coverage is meant to include this group.

While the insurance carrier may be able to provide this information, the nuance may confuse a call-center representative, and so we also think it’s best to reach out to someone in Human Resources at your employer, likely with a title that includes “Benefits” or “Total Rewards.”