September 07, 2023

Employers have an important stake in helping employees and dependents who pursue fertility treatments find high-quality providers and in ensuring access to the most effective options. In response, more employers are collaborating with specialized vendors to expand coverage for evidence-based fertility treatments and help those going through treatment with navigation, rather than solely focusing on cost considerations. By doing so, employers can improve maternal and child health outcomes while reducing medical expenses for employees and dependents. This section explores various strategies and resources available to employers, empowering them to enhance employee decision-making throughout the fertility treatment process.

Evidence-based Approach to Fertility Care

Employers are realizing that offering access to evidence-based fertility care can ensure that employees receive the most effective and safe treatments currently available. By adopting an evidence-based approach, patients can minimize their risks and enhance their chances of a successful pregnancy. To ensure that employees have access to top-tier fertility specialists and facilities, increasing the likelihood of successful outcomes, employers often establish partnerships with centers of excellence (COEs) that have a proven track record of delivering high-quality care and adhering to evidence-based practices. According to Business Group on Health’s 2024 Large Employer Health Care Strategy Survey, 57% of large employers respondents will offer fertility/family-forming COEs in 2024, with an additional 15% considering doing so for 2025/2026.

For employers who cover fertility benefits, a reimbursement dollar cap model may not equate to better outcomes, as there is no alignment of values in terms of quality of care and cost. For employers who have a reimbursement dollar cap model in place, however, an unintended consequence is that employees may try to get "the biggest bang for their buck" by selecting the lowest-cost provider or clinic that transfers multiple embryos, potentially leading to multiple births and time spent in a neonatal intensive care unit. Such clinics may also forgo tests or procedures like elective single-embryo transfer (eSET), which help drive success and healthy pregnancies. eSET is when a single embryo is transferred from a pool of multiple, viable embryos and is the only recommended way to avoid the risk of multiple gestations after in vitro fertilization.⁶⁴ Following eSET protocols directly influences the rate of multiple births. It should be noted that when requirements to only use eSET practices are in place, the rate of multiple births decreases while the rate of pregnancy tends to remain the same.⁴⁵

In a U.S. study of infertile women undergoing a combined 15,418 IVF/embryo transfer cycles, patients with infertility benefits electively chose to transfer one embryo/cycle significantly more often than patients with no coverage, thereby reducing costs due to multiple births.⁴⁶ In fact, 27% of employers who offer fertility benefits require their health plans’ in-network reproductive specialists to adopt a eSET policy.¹³ Various countries have taken different approaches when it comes to embryo transfer. For instance, Argentina has moved toward eSET, while countries such as Brazil and Mexico continue to practice multiple embryo transfer.⁴⁷

Navigating the Journey

The journey toward parenthood can be emotional and stressful. As part of a comprehensive offering, employers may want to consider support programs that help guide employees through their conception and family-forming journey. Health plans are increasingly offering their own fertility programs that coordinate with maternity support programs when the employee becomes pregnant.

Employers also may consider the use of navigational services through their health plan or a third-party vendor. Such services can not only guide employees to high-quality information and providers, but also ensure their enrollment in other applicable programs aimed at easing their transition into parenthood. In a U.S. study, patients were provided with comprehensive support, education and clinical-based treatment plans that prioritized clinical criteria over costs. The results, when compared to national benchmarks, revealed greater pregnancy success, healthier pregnancies and healthier babies.⁴⁸ If fertility is not the right path to parenthood or doesn’t work, employees can be guided to other programs that may be offered, such as adoption or surrogacy.

According to a survey conducted by the Royal College of Obstetricians & Gynecologists, 62% of women in the U.K. expressed feeling overwhelmed by the abundance of advice they received.⁴⁹ Notably, the U.K. and Armenia are the sole European countries with state-organized fertility education programs aimed at assisting individuals in navigating fertility care and challenges.⁵⁰ In fact, partnering with a global vendor to assist employees in navigating family-forming options can provide valuable education on the range of family-forming options available and dispel common misconceptions.

Managing Fertility Drugs

Pharmacy costs often form a significant portion of the overall expenses incurred in fertility treatments. Therefore, delays in care and access can quickly drive additional costs and derail treatment. One of the ways employers can ensure that their fertility benefits are effective is to have timely, barrier-free access to fertility medications available for employees. Having all medications administered by one pharmacy benefit manager (PBM) may ease administration and efficiency in managing specialty medications for employers, but patient needs and preferences should be taken into consideration as employers evaluate their fertility benefit design. Considerations can include:

This section was informed by members of Business Group on Health’s Pharmacy Benefit Committee.

Outcomes Do Matter

Similar to how physicians rely on patient data to evaluate treatment responses and guide future treatment options, the availability of high-quality data on patients today presents a unique opportunity for employers to measure outcomes to determine if the benefits in place are effective. Employers can utilize a range of metrics to help them understand the effectiveness of their fertility and family-forming benefits and determine whether employees are successfully pursuing their family-forming aspirations. These metrics are shown on Table 1⁶⁰:

Table 1: Metrics for Assessing the Effectiveness of Fertility and Family-forming Benefits

Access	Quality/Success	Cost	Experience
Where can employees access care and how can different support modalities be used depending on patient location and needs.	Rates for eSET, pregnancy, miscarriage and live birth provide insights into the program's effectiveness in helping employees achieve their family formation goals.	Bundled case rates and total costs for patients provide an understanding of both plan expenses and employees' out-of-pocket costs.	Patient experience on how the fertility benefits solution impacts employees' emotional well-being and overall treatment journey.

Opportunity to Prioritize Quality and Affordability

The demand for fertility treatments has grown considerably in recent years, reflecting a changing workforce and treatment landscape. Employers may run the risk of employees using affordability as the main criteria for provider and treatment selection instead of quality or overall health outcomes if the levels of coverage are not reviewed in the context of the latest evidence and clinical advancements. Employers can design their benefit to help employees find high-quality providers and the most effective treatment through a comprehensive fertility benefit while controlling their long-term cost trend associated with overall family planning and health care services.

Employer Recommendations

• 1 | Promote superior clinical outcomes: Guide members toward high-quality providers who adhere to evidence-based protocols, including eSET, and consistently deliver exceptional clinical outcomes.
• 2 | Examine existing benefits: Reassess fertility treatment benefit limits to ensure that not only is the initial fertility consult included, but subsequent visits and treatments are also included as defined by the plan limits.
• 3 | Assess gaps in coverage: To promote equity among all employees, it is important to understand the services provided by public health systems in countries outside the U.S. This will help ensure sufficient coverage within the employer's health care plan.
• 4 | Prioritize quality and accessibility: Evaluate programs with proven quality, clinical and patient satisfaction outcomes.
• 5 | Streamline access to fertility treatment: Remove unnecessary requirements for accessing fertility treatment, especially when implementing enhanced benefits such as COEs or fertility vendors, to ensure that employees can easily avail themselves of the necessary care.
• 6 | Measure outcomes: Utilize available high-quality data to measure the effectiveness of your fertility programs.
• 7 | Enhance member navigation: Create strong links among various programs to offer comprehensive support for parents throughout the family-forming journey. Facilitate smooth transitions from prenatal care and pregnancy visits to postpartum and maternity programs. Collaborate with a vendor partner for global fertility programs to assist employees in navigating local fertility options.
• 8 | Drive global consistency: Partner with a vendor that can support you globally and allow for a globally consistent strategy. Focus on countries where access is easier to obtain while continuing to monitor how to meet employees’ needs in more restrictive markets.
• 9 | Stay informed about coverage landscape: Stay vigilant in monitoring regulatory requirements and mandates for fertility treatments and family-forming benefits globally to ensure ongoing compliance.

This Guide is for Business Group on Health members only. It should not be reproduced, distributed or quoted without permission from Business Group on Health

More Topics

Articles & Guides