White House actions seem unlikely to move the needle on workplace fertility benefits

The White House recently rolled out several policies that seek to deliver on President Donald Trump’s campaign promise to expand access to in-vitro fertilization (IVF).

EMD Serono, a fertility medication manufacturer, will offer certain drugs at a reduced cost exclusively through TrumpRx, the White House said in a fact sheet published on Oct. 16.

Additionally, the administration clarified that employers can offer fertility services as a standalone benefit, akin to how dental or vision insurance is often offered. The Department of Labor (DOL) issued guidance that details how businesses may go about this, but it’s unclear whether the policy will spur more companies to cover fertility treatment.

A not-so-new benefit option. The policies recently rolled out by the White House follow an executive order seeking to protect and reduce the cost of IVF, but fall short of the president's campaign trail promises. Employers won’t be required to cover IVF, nor does the administration plan to offer any financial incentives for them to do so, at least for the moment.

Instead, several federal agencies announced that “employers can now offer standalone benefit packages to employees interested in coverage for treatment of infertility, including IVF,” the White House said. The DOL guidance clarified that employers can cover fertility treatments through an “excepted benefit,” which is a type of benefit that isn’t subject to certain requirements under laws like the Affordable Care Act and the Health Insurance Portability and Accountability Act.

The agency also said it planned to propose a rule “aimed at providing additional ways that certain fertility benefits may be offered as a limited excepted benefit.”

Will more employers cover IVF now? While the excepted benefit recommendation was framed as a “new benefit option” for employers, the guidance doesn’t actually create any new pathways for companies to cover IVF, sources told HR Brew.

“I read this much more as maybe an affirmation of what was already possible, as opposed to new policy,” said Katie Keith, director of Georgetown Law’s Center for Health Policy and the Law. The types of excepted benefits the DOL points to—such as reimbursing an employee’s out-of-pocket costs through a Health Reimbursement Account, or offering fertility treatments through a specified illness policy—are currently possible, but may not make sense from a design perspective.

Nearly one-half (47%) of large employers cover IVF services in their largest medical plan, according to Mercer’s most recent survey on employer-sponsored health plans. And there’s a reason many employers choose to incorporate IVF into their group health plans, rather than offer it as a standalone benefit, Keith said. IVF patients have to undergo many different types of care, from taking prescription drugs to undergoing lab testing to ultimately seeking out providers for their pregnancy journeys, if the procedures are successful.

“I understand why employers would sort of treat it as part and parcel of their entire benefits package, because the care is so cross-cutting,” she said. While the Trump administration’s proposals may work for a “very narrow” benefit, “I just don’t think this gets you to the kind of comprehensive coverage that is being talked about,” Keith added.

Celebrating small wins. Companies that provide fertility benefits were already offering the White House-endorsed options to their customers, but executives in the sector expressed optimism that these recent policies would move the needle even further on employer-sponsored coverage.

Carrot, a workplace fertility benefit provider, launched a “flex program” allowing employers to purchase its pharmaceutical benefit as a standalone option shortly after the White House rolled out its policies. The company’s CEO, Tammy Sun, told STAT she believed the moves marked “a really important moment” for the category of benefits Carrot sells.

Employers have increasingly designed fertility benefits as a “carve-out” from their health plans in recent years, Neel Shah, chief medical officer with Maven Clinic, another fertility benefit provider, told HR Brew via email. The excepted benefit approach that the White House supports “​​enables the shortest pathway to a healthy pregnancy, at the lowest possible cost, for most people,” he added.

Shah also pointed to the administration’s efforts to lower the cost of fertility medications, which represent “approximately one-third of the total costs of IVF,” he estimated. A full IVF treatment cycle can cost from $15,000 to $20,000 on average, and the potential for incurring increased health costs has historically been a top reason employers don’t cover it.

The deal to lower prices of some commonly used fertility drugs may help address this concern, but doesn’t tackle other types of treatment that contribute to the high cost of IVF, such as lab visits and embryo storage, Politico noted.