Costly Fertility Medications Drive Patients to Underground Market

Some consumers are buying others’ leftover fertility medications over the Internet without any assurance the drugs are safe or effective.

What would drive a patient to buy medications without a valid prescription and without any verification the drugs have been stored and shipped at the proper temperature?

Reproductive medicine, infertility association and online pharmacy safety groups tell me the reason is the lack of coverage for infertility treatments.

“The entire issue is yet another example of how out-of-pocket costs are impacted by the lack of insurance coverage for infertility treatments,” Andy Schwartz, director of public relations for RESOLVE: The National Infertility Association, told Bloomberg Law.

The drugs cost up to $5,000 per cycle of in-vitro fertility (IVF) treatment, and many patients undergo multiple cycles. Drug costs can run even higher for older patients who might require higher dosages to stimulate egg production.

And only 15 states mandate insurance coverage for fertility treatments. Those states are Arkansas, California, Connecticut, Hawaii, Illinois, Louisiana, Maryland, Massachusetts, Montana, New Jersey, New York, Ohio, Rhode Island, Texas and West Virginia. But even those state laws contain exemptions.

For example, even in those states with mandated insurance coverage for fertility treatments, self-insured employers are exempt from state law and don’t have to offer fertility benefits. Smaller companies may not have to provide coverage either. Only four percent of employers with fewer than 50 employees offer fertility services, according to a 2016 study from the International Foundation of Employee Benefit Plans. Read my article here.

Stay on top of new developments in health law and regulation, and learn more, by signing up for a free trial to Bloomberg Law.