Requiring Coverage for IVF

By Margie Donlon and Luanne Peterpaul

Luanne Peterpaul and Margie Donlon

We are strong advocates for women’s access to in vitro fertilization (IVF).

IVF is a life-changing medical procedure that has enabled thousands of New Jersey couples to start families.

That’s especially true for women who undergo medical treatments that can cause infertility. Women facing cancer and other medical conditions should not have to go into their treatment also worrying whether what heals them will prevent them from having children. That’s an awful emotional burden to carry on top of concerns about the impact of side effects of treatment and whether it will cure them.

That’s why we have introduced legislation to require Medicaid coverage for fertility preservation services in cases of iatrogenic infertility. Iatrogenic infertility is when a medical procedure or treatment such as chemotherapy, radiation, and surgery, directly or indirectly damages reproductive organs or processes, causing infertility.

Many women and men faced with these unavoidable and unpredictable side effects of medically necessary treatments choose to “freeze” their eggs or sperm before starting treatments in case they have difficulty becoming pregnant after treatment. But storing their eggs until they are well enough for IVF can be expensive and isn’t always covered by their health insurance.

Our bill would require the State Medicaid program and the Plan First program to cover standard fertility preservation services in cases where a medically necessary treatment may directly or indirectly cause iatrogenic infertility. (The State’s Plan First program provides a benefit package of family planning and family planning-related services and supplies for individuals whose annual incomes are below 205 percent of the federal poverty level and who are not otherwise eligible for Medicaid or the NJ FamilyCare program.)

A 2019 state law required state-regulated health insurers, the State Health Benefits Program (SHBP), and the School Employees Health Benefits Program (SEHBP), cover standard fertility preservation services if a medically necessary treatment may directly or indirectly cause iatrogenic infertility. But the statute did not include the storage of sperm and immature ovum, or egg cells.

Our bill also calls for insurance coverage of “standard fertility preservation services” that meet established medical practices and professional guidelines. These are treatments that enable women to undergo IVF and they include the storage of sperm, immature ovum (or egg cells),

embryos, and cryopreserved ovarian tissue.

This legislation is part of our commitment to ensuring health care access to all residents. We’d like to thank Attorney General Platkin and the Division of Consumer Affairs Acting Director Cari Fais for their recent announcement of new rules promoting greater transparency in prescription drug pricing.

For too long, New Jersey families have struggled with the unpredictability and unaffordability of rising prescription drug prices. As co-sponsors, along with LD11 legislative partner, Senator Vin Gopal, of the groundwork legislation, it is gratifying to see rules implemented that will increase transparency in drug pricing and address the rising cost of prescription drugs.

Affordability should not be a barrier for any patients in getting the care they desperately need to be healthy. When we ensure access to health care we make our state more affordable, safer, and equitable for all residents.

One important final note: Today, Oct. 31, is the deadline to apply for the Senior Freeze Property Tax Reimbursement. Seniors filling a new application, or making changes to a prior application, must submit their application today. Legislative District 11 residents who need an application or help filing one, should contact our office at (732) 695-3371 for assistance right away.