Memorial Sloan Kettering Cancer Center

Memorial Sloan Kettering Cancer Center (MSK) supports the enactment of S7219 (Savino) / A10137 (Simotas) – the Fair Access to Fertility Treatment Act, which requires insurance coverage for in vitro fertilization (IVF) and fertility preservation services for large group policies.

Improvements in cancer treatment have made it possible for more people to live longer, healthier lives after cancer. But many of these new therapies also carry a risk of affecting the ability to have children. Today there are a number of options available for people with cancer who wish to preserve their fertility before treatment begins or start a family after their treatment is completed. The Fair Access to Fertility Treatment Act includes provisions for coverage of fertility preservation services which patients may utilize before receiving a medical treatment, such as cancer therapy, that causes iatrogenic infertility (infertility resulting from surgery, radiation, chemotherapy or other medical treatment affecting fertility.)  Fertility preservation services include sperm banking, egg freezing, and embryo freezing.

In 2014, approximately 500 men and 900 women ages 18-45 began treatment for cancer at MSK. About 50% of these patients received treatment that poses a risk of infertility.  Recognizing the significance of fertility to cancer survivors, MSK provides resources and services to ensure patients are informed about options to preserve fertility before beginning cancer treatment, as well as options to build a family after treatment is completed. In addition to information provided by the treating oncology clinicians, we have designated Fertility Nurse Specialists available to provide in depth education and counseling. Since the inception of the program, they have counseled over 2,000 patients, 69% specifically about fertility preservation. Although many patients want to pursue fertility preservation, financial costs pose a significant obstacle, preventing many from accessing this technology. MSK believes that having cancer should not preclude someone from having biological children. Passage of the Fair Access to Fertility Treatment Act would enable our patients and others across New York State to have access to these important services.

For the above reasons, MSK strongly supports the enactment of S7219 (Savino) / A10137 (Simotas). Thank you for your consideration. If you have any questions, please contact Elisabeth Mayer, Legislative Specialist (mayere@mskcc.org / 646-227-2203).

Columbia University Medical Center

THE FAIR ACCESS TO FERTILITY TREATMENT ACT

MEMORANDUM IN SUPPORT

S.7219 (Savino) / A.10137 (Simotas)

Statistics show that one in eight individuals or couples have trouble getting pregnant or sustaining a pregnancy. Infertility cuts across socioeconomic levels, and all racial, ethnic and religious lines. Medical conditions such as endometriosis, ovulation disorders, luteal phase defect, premature ovarian failure and male factor are some causes of infertility. The American Congress of Obstetricians and Gynecologists and the World Health Organization recognize infertility as a disease. As such, infertility should be covered by health insurance like other diseases.

Sixty-seven percent of affected individuals or couples report spending at least $10,000 on adoption and medical treatment for infertility. In fact, cost is the number one barrier to seeking family building assistance, since 46% of affected people lack insurance coverage for infertility disease treatment. Since 1990, New York has required coverage of some infertility treatments in the commercial insurance market. However, current law does not require coverage for IVF, or in-vitro fertilization. New York should join the growing number of states that require IVF coverage.

The Fair Access to Fertility Treatment Act requires insurance coverage for IVF for large group policies. It adds a definition of infertility, which makes clear that infertility is a disease as diagnosed by a licensed physician or by the failure to become pregnant after 12 months of regular, unprotected intercourse. The bill also provides for coverage of fertility preservation services when a medical treatment, such as cancer treatment, causes iatrogenic infertility. Iatrogenic infertility is defined as infertility resulting from surgery, radiation, chemotherapy or other medical treatment affecting fertility. The bill also adds non-discrimination protections that are consistent with the Affordable Care Act.

At Columbia University Medical Center we have robust oncology and stem cell transplant programs, but our patients regularly face financial barriers in trying to maintain options for their reproductive future. CO, for example, is a young woman with sickle cell anemia requiring a stem cell transplant. While the prognosis is good, the treatments will likely leaver her sterile. After discussing the issue with her doctors and her family, CO elected to freeze some of her eggs prior to the transplant procedure, thus leaving the possibility that she could at some point in the future consider a pregnancy with a biologic child. CO and her family had to pay $5000 out of pocket for this process, since it was not covered by her insurance. Fortunately, she and her family were in a position to do so, but so many others are not.

We can treat patients like CO, but sterility can be an unavoidable side effect.  Fortunately, there are ways to preserve a patient’s reproductive future, but unfortunately many of these methods are not covered by most health insurance policies and are cost prohibitive for many families.  CO can one day have children, despite her earlier serious illness.  This is what we want for all of our patients.

Infertility treatment, including IVF, has advanced considerably since New York passed its laws. IVF is now considered the standard of care for many persons seeking treatment for infertility disease. For many patients, IVF increases the chance of singleton births. A reduction in multiple births decreases health care and other costs and can result in healthier babies. In states that require coverage for infertility, including IVF, insurance premiums increased only slightly.

For the above reasons, we urge the Legislature to pass this bill.

Weill Cornell Medicine

Dear Senator Savino,

I would like to personally thank you for championing legislation in the New York State Senate that would amend the insurance law in New York State to allow for the coverage of in vitro fertilization and fertility preservation treatments for patients, which we strongly support here at Weill Cornell Medicine.

Recognize by both the American Congress of Obstetricians and Gynecologists and the World Health Organization as a disease, infertility affects thousands of patients across all socioeconomic levels and can be emotionally and financially devastating. Access to treatment should not be cost prohibitive. Insurance coverage for fertility preservation should be available to those who suffer side effects from treatment of diseases such as cancer in the same way that treatment for other side effects is covered. Senate Bill S3148 can alleviate such barriers individuals face in maintaining agency for their reproductive future.

The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, led by Dr. Zev Rosenwaks here at Weill Cornell, has been at the forefront of scientific innovation that has yielded exceedingly successful and positive outcomes for our patients who are faced with the emotional and financial challenges associated with infertility. Efforts on behalf of the state, such as the New York State Infertility Demonstration program, have benefited patients, however there is more that can be done to increase access, and we support your efforts in this area.

Sincerely

Augustine M.K. Choi, M.D.

Roswell Park Cancer Institute

Roswell Park Cancer Institute

Memorandum of Support

A.2646 (Simotas)/ S.3148 (Savino)

The Fair Access to Fertility Treatment Act

Roswell Park Cancer Institute located in Buffalo, New York and the only National Cancer Institute-designated comprehensive cancer center in Upstate New York, STRONGLY SUPPORTS this legislation that includes provisions for coverage of fertility preservation services which patients may utilize before receiving a medical treatment, such as cancer therapy, that causes iatrogenic infertility (infertility resulting from surgery, radiation, chemotherapy or other medical treatment affecting fertility). Fertility preservation services include sperm banking, egg freezing, and embryo freezing.

Roswell Park Cancer Institute treats many patients each day who struggle with infertility after their cancer treatment. This is especially true for adolescent and young adult patients who face a higher probability of becoming infertile from the effects of the treatment for the cancer. In fact, over 10% of the nation’s cancer patients are in their reproductive years. Finding ways to have biological children one day is an important part of planning for their life after cancer.

Modern medicine has come a long way for those hoping to have biologic children. Preserving fertility through freezing eggs, embryos and sperm before initiation of chemotherapy and using in-vitro fertilization (IVF) helps cancer survivors to successfully conceive children. However, planning for future fertility or trying to conceive after treatment comes at a cost. While insurance covers the treatment and effects of cancer, fertility preservation and most infertility treatments are not covered. Patients who are already burdened with a life threatening medical emergency, medical bills or income loss because of their illness must pay these costs out of pocket. For many these costs are prohibitive, and future fertility is left to chance.  These costs also often keep doctors from suggesting preservation and patients from seeing it as a viable option.

There are some patients who even delay or forego treatment while trying for a family, putting themselves and a fetus at greater risk.

Roswell Park Cancer Institute supports this legislation which would enable cancer patients the opportunity to access important fertility and fertility preservation services.

American College of Obstetricians and Gynecologists

Memorandum of Support

An act to amend the insurance law, in relation to insurance coverage of in vitro fertilization and other fertility preservation treatments A.2646 (Simotas)/S. 3148 (Savino)

The American Congress of Obstetricians and Gynecologists (ACOG), District II, supports access to in-vitro fertilization (IVF) treatment and reproductive care for all individuals regardless of individual characteristics, such as age or sexual orientation.

The legislation seeks to remove some of the barriers individuals face when deciding to undergo IVF treatment by requiring large group insurance policies to cover IVF and removing discriminatory age requirements previously in place. The definition of infertility is also clarified in the legislation to describe infertility as “a disease characterized by the incapacity to impregnate another person or to conceive, as diagnosed by a physician

licensed to practice medicine in the state, or by the failure to establish a clinical pregnancy after twelve months of regular, unprotected sexual intercourse.”

According to the American Society for Reproductive Medicine (ASRM), infertility is a disease that can profoundly impact an individual’s life, causing medical, social, economic, and psychological harm. Approximately 12% of women age 15-44 years old struggle to conceive or carry a pregnancy to term. The ability of women to become pregnant (fecundity) gradually decreases as they age, with fecundity significantly decreasing at age 32 and even more rapidly at age 37. Infertility can affect both men and women of all races, ethnicities, orientations, and socio-economic status, making it an important public health issue.

IVF is an effective treatment option for individuals with infertility who want to have children but otherwise cannot conceive. It does however come at a high cost for those individuals who lack health insurance or whose health insurance does not cover fertility treatments. The ASRM reports that the median price for a cycle of IVF is $19,200 out of pocket.

The benefits of insurance coverage for infertility to both patients and providers are significant. Patients are able to receive the appropriate, necessary medical treatment without substantial financial strain and providers are able to provide care not based on what a patient can afford, but rather on what is medically necessary. Six states provide coverage for the diagnosis and treatment of infertility, including IVF, through state law mandates.

Additionally, the Department of Veterans Affairs recently amended their regulations to include fertility counseling and treatment, including IVF, to veterans and spouses whose infertility results from a serviceconnected disability. In passing this legislation, New York would join these states and departments in addressing this important public health issue.

ACOG District II urges policymakers to establish affordable, safe, and effective infertility treatments for the residents of New York and as such, supports the passage of this legislation.

UJA Federation New York

Union of Orthodox Jewish

Congregations of America