New law in Rhode Island mandates fertility preservation coverage prior to medical treatment

Rhode Island has become the first state to pass a law explicitly requiring coverage for fertility preservation prior to gonadotoxic medical therapy, treatment that could directly or indirectly cause infertility.

Clinicians from the Fertility Center and Program in Women's Oncology/Breast Health Center at Women & Infants Hospital of Rhode Island, a Care New England hospital, initiated the legislative process, co-wrote the bill, and along with patients testified on behalf of its passage at hearings at both the Rhode Island House of Representatives and Senate. This law explicitly mandates fertility preservation coverage prior to medical treatment that could render a patient infertile, setting a new precedent nationwide. On July 5, Governor Gina Raimondo signed into law legislation 2017-S 0821A, 2017-H 6170A that was sponsored by Senate Majority Whip Maryellen Goodwin (D-Dist. 1, Providence) and Representative Patricia A. Serpa (D-Dist. 27, West Warwick, Coventry, Warwick).

Approximately 10 percent of more than 100,000 new cancer diagnoses in the United States are in patients under the age of 45. Advances in cancer therapies, particularly chemotherapies, have led to dramatic improvements in patient survival, and thus a growing population of cancer survivors who wish to start a family.

According to Eden Cardozo, MD, a reproductive endocrinologist with Women & Infants' Fertility Center and assistant professor in the Department of Obstetrics and Gynecology at The Warren Alpert Medical School of Brown University, "Unfortunately, in nearly 90 percent of cases, these treatments result in infertility, which has been shown to have negative physical and psychological consequences. There are options currently available to preserve the fertility of these patients, but the unfortunate reality is that without insurance coverage, most patients can't afford to see a reproductive specialist for these services." Ruben Alvero, MD, director of the Division of Reproductive Endocrinology and Infertility at Women & Infants and the Warren Alpert Medical School, credits Dr. Cardozo with developing the idea for the legislation. This physician team, along with government affairs and legal teams, shepherded the legislative process for fertility preservation coverage in Rhode Island.

Ashley R. Stuckey, MD, a gynecologic oncologist and breast surgeon at Women & Infants and Kent hospitals and assistant professor of obstetrics and gynecology at the Warren Alpert Medical School, also testified, saying, "A diagnosis of cancer in these young patients is devastating, which is compounded by the likelihood that their treatment, which may include sterilizing surgery, chemotherapy, or radiation, will render them infertile. At the time of a cancer diagnosis, time is of the essence. Typically, treatment will begin within two to three weeks of diagnosis, and fertility preservation may take up to two weeks. Our patients do not have the luxury of the added time that is required to petition insurance companies or secure additional funding to pay for these procedures that are typically cost prohibitive when not covered by insurance."

In her testimony, Dr. Stuckey described a patient who she cared for along with Dr. Cardozo. The patient's chemotherapy was "significantly delayed while she desperately tried to pull together the funds needed for a fertility preservation cycle." Dr. Stuckey said, "The opportunity to preserve her future fertility was so important to her that she was willing to assume the personal health risk of delaying her cancer treatment - a decision she never would have had to make had her insurance provided fertility preservation coverage."

Legislation aimed at providing fertility preservation coverage was passed in Connecticut in June, which revises the definition of infertility to include "medically necessary" treatments. The Rhode Island law provides a separate definition, which explicitly mandates fertility preservation coverage prior to gonadotoxic therapies.

Richard J. Paulson, MD, president of the American Society for Reproductive Medicine (ASRM), shared, "ASRM applauds its colleagues in Rhode Island and lawmakers in the state for working together toward the enactment of a new precedent-setting law explicitly requiring insurance coverage for fertility preservation for patients needing medical treatments which are likely to cause infertility. It is our goal that other states will follow the direction of Rhode Island and Connecticut in recognizing the need for insurance to cover these treatments for oncology patients and others who should not have to choose between their own health and their ability to have children."

"If infertility is a risk of the treatment a patient needs, fertility preservation is a medical need that should also be covered by insurance. It's not acceptable that a person who is already coping with cancer and its treatment, for example, should also be dealt the blow of being potentially robbed of the ability to have children when there is a way to protect them. Insurers should be covering fertility preservation in this situation because it is necessary to protect patients from losing a very precious biological ability," said Senator Goodwin (D-Dist. 1, Providence).

Said Representative Serpa (D-Dist. 27, West Warwick, Coventry, Warwick), "This will affect only a handful of patients in Rhode Island each year, but for those that it does, the stakes are high. On one hand, better cancer detection means that more people are getting the treatment they need in earlier stages, including young people whose cancer might have previously gone undetected for a long time. On the other hand, when someone young undergoes treatment, they shouldn't have to sacrifice their ability to have children someday in the future, nor should they be faced with a choice of either accepting that loss or trying to pay for fertility preservation themselves. Fertility is part of health, and it should be covered as part of their treatment."

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