RI requires coverage for ‘fertility preservation’ by private insurers – The Providence Journal

New law was designed for cancer patients whose treatment could leave them sterile, but it may also apply to transgender people undergoing hormone-replacement therapy.

PROVIDENCE, R.I. Rhode Island has enacted a new law that requires private insurers to cover "fertility preservation" for people who undergo medical treatments that may leave them sterile.

The legislation believed to be the first in the country was designed to help cancer patients of childbearing age whose chemotherapy treatment usually renders them infertile.

The law also could expand access to fertility-preservation services for another group of Rhode Islanders who have historically had trouble getting coverage: transgender people.

Nationally, more than 100,000 people under age 45 are diagnosed with cancer in the U.S. each year, according to the National Cancer Institute. In nearly 90 percent of the cases, their treatment results in infertility, said Dr. Eden Cardozo, a reproductive endocrinologist at Women & Infants' Fertility Center, who came up with the idea for the legislation.

In Rhode Island, roughly 375 people under age 40 are diagnosed with cancer each year, about 63 percent of them women.

"There are options currently available to preserve the fertility of these patients," Cardozo said in a statement, "but the unfortunate reality is that without insurance coverage, most patients can't afford to see a reproductive specialist for these services."

Hormone-replacement therapyfor people diagnosed with gender dysphoria can result in temporary or permanent sterility, and many transgender people now use fertility-preservation technologies, according to a 2016 article in the American Medical Association Journal of Ethics.

"We have a number of patients who have donated or saved their sperm," Dr. Michelle Forcier, a pediatrician who provides hormone-replacement therapy for transgender children and adolescents at Lifespan's Gender and Sexual Health Services Center. "We've had a smaller number of patients who have had their eggs frozen. And thebig issue for all these is cost. Insurance does not cover it."

The cost of fertility preservation, on average, runs over $10,000 for women and about $1,000 for men, according to the Livestrong Foundation, a national nonprofit based in Texas that serves cancer patients. That doesn't include the additional $300 to $500 per year for storage.

Kimberly Lyons was trying to get pregnant earlier this year when she was diagnosed with leukemia.Lyons, 30, a school psychologist in Warwick, was told that her best chance of survival was a stem cell transplant followed by multiple rounds of chemotherapy.

"When I was in the ICU," she said, "I was like, 'I don't even care if I have cancer. Am I gonna be able to have my babies?'"

She and her husband, Robert, have coverage through Blue Cross Blue Shield of Rhode Island, which this year began covering fertility preservation for people whose medical treatments could render them sterile.

Their Blue Cross policy covered 80 percent of the cost of their fertility preservation, which included a round of in vitro fertilization, Lyons said. The couple raised money to cover the other 20 percent plus medication costs, she said, which came to about $6,500.

"That's really been pushing me to get stronger to fight this [disease]," she said, "because I know I have that opportunity that I will still have the chance to become a mother biologically."

Blue Cross covers fertility preservation for anyone who will be undergoing medical treatment "such as chemotherapy, radiation therapy or gender reassignment, that is likely to result in infertility," Jill Flaxington, a Blue Cross spokeswoman, said in an email.

But others said they were unclear how the new state law would be applied.

Neighborhood Health Plan of Rhode Island is "currently reviewing and determining how to best incorporate these state policy changes into our commercial plans," Dr. Tracey Cohen, medical director, said in a statement. "Neighborhood's longstanding mission seeks to connect everyone in our state to high-quality, affordable care, and that commitment certainly extends to people in Rhode Island's transgender community."

The Rhode Island Office of the Health Insurance Commissioner (OHIC), which regulates private insurers, said in a statement that the agency is "committed to supporting the medical needs of transgender Rhode Islanders." However, the statement said, "this particular question has not been raised to our office previously."

Rhode Island's health insurance regulations prohibit discrimination based on gender identity, including "medically necessary transgender surgery and ... related health care services."

OHIC said it has to research the matter to determine if the new law will "apply to medically necessary hormone replacement therapy (HRT) and sex-reassignment surgery."

The new legislation, which Gov. Gina Raimondo signed into law on July 5, requires private insurers to cover fertility preservation services when a "medically necessary medical treatment may directly or indirectly" result in infertility. The coverage can have a lifetime cap of $100,000.

One oncologist estimated that "maybe eight or nine [patients] might use this method,"said Rep. Patricia A. Serpa, D-West Warwick, the sponsor of the House bill (6170 SUB A). "So with the transgender population, I'd expect there might be two or three at the most."

Sen. Maryellen Goodwin, D-Providence, the sponsor of the Senate bill (821 SUB A), could not be reached Tuesday.

The new law does not apply to the government-funded insurers, Medicare and Medicaid.

larditi@providencejournal.com

(401) 277-7335

On Twitter:@LynnArditi

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RI requires coverage for 'fertility preservation' by private insurers - The Providence Journal