Louisiana Declines Fertility Preservation in Patients With Cancer

Roxanne Nelson, RN, BSN

June 16, 2022

Lawmakers in the state of Louisiana have blocked a bill that would have required insurance companies to cover fertility preservation procedures for patients with cancer before they undergo treatments that could render them sterile.

Treatment-related infertility is an important survivorship issue that can affect future quality of life. The American Society for Reproductive Medicine and the American Society of Clinical Oncology recommend that clinicians discuss fertility preservation with adult and pediatric patients prior to the initiation of anticancer therapy, but these procedures can be expensive if patients are forced to pay out of pocket.

The legislation in Louisiana, House Bill 537, sponsored by Representative Paula Davis (Republican-Baton Rouge), was declared too expensive by the Louisiana Senate Finance Committee. The Committee noted that it would have included state workers and public school teachers, who are insured through the state, to receive the coverage. Louisiana would also have had to cover any costs from private health plans that were purchased on the state insurance exchange.

Currently, many insurance plans operating within Louisiana do not pay for the extraction of eggs and sperm from individuals who need to undergo medical treatment that will likely result in infertility. Patients with cancer figure prominently, as standard treatments such as radiation and chemotherapy can compromise the fertility of children, adolescents, and young adults.

"The decision by Senate Finance to kill this legislation is regrettable," commented State Rep. Tanner Magee (Republican-Houma), in a news report in Lancet Oncology.

 "Every Louisiana citizen should be able to have the right to medical assistance in having children — especially patients with cancer. Having children is the most essential life function and a right, not a luxury. Insurance should cover all essential medical needs."

HB 537 was intended to close that gap by requiring coverage for new health plans in 2023 and existing health plans in 2024.

Amended Bill

Davis first introduced HB 537 in the House in March and referred it to the Committee on Insurance. The committee passed the bill and sent it back to the House for debate, but while on the House floor, the bill was further amended to cover only fertility preservation for those at risk of medically-induced infertility.

The original intent of the bill was to mandate coverage for a broad range of infertility treatment options, such as in-vitro fertilization (IVF), which is currently offered in neighboring states. For example, Texas mandates that health insurance cover the cost for IVF, and in Arkansas, private health plans are expected to cover part of the cost of these treatments. But HB 537 was amended on the house floor on May 24, removing the provisions mandating insurance coverage and tax-payer coverage of IVF. 

The bill then sailed through the House unanimously, 97-0, and was sent on to the Senate, where it stalled and ultimately failed to pass.

Davis faced opposition to HB 537 in its original form from insurance companies, Catholic bishops, and anti-abortion groups. Insurance companies complained that coverage for would be too expensive and drive up premiums by a few hundred dollars, and the Catholic church and pro-life groups oppose IVF because of the destruction of discarded embryos.

In the final version of HB 357, the only mandated coverage would have been  for extraction and freezing of eggs and sperm separately — not as a fertilized egg or embryo. And to reduce the financial burden on the state, Davis was willing to compromise further and exempt health plans offered by the Office of Group Benefits, the company the provides insurance to most of the state employees and public school teachers. However, even that wasn't sufficient to get the bill through the Senate.

Questionable Fiscal Analysis?

A news article in The Advocate in Baton Rouge questions the financial estimates that resulted in the state declaring the bill as too expensive. The financial impact to health plans was estimated to be between $1.6 million and $4.9 million per year by the middle of 2026, the newspaper reports. However, this amount was based solely on data provided by Blue Cross and Blue Shield of Louisiana, a company that lobbied against the legislation.

This has caused some of the lawmakers to question whether Louisiana's fiscal analysis was even accurate, and proponents of the bill have also argued that the estimated cost to the state of providing fertility treatment is inflated. They point out that only about 2200 people per year, including those in the private sector, would be able to qualify for the coverage in the amended bill, but the Office of Group Benefits estimated that the cost would run about $1.8 million per year. That number is significantly higher than seen in other states.

Davis is expected to renew the proposal next year after an official study of the costs, which includes asking legislators to approve studying the cost of imposing an insurance requirement to cover fertility treatments, including IVF, in order to gauge more accurate estimates of the financial burden.

Roxanne Nelson is a registered nurse and an award-winning medical writer who has written for many major news outlets and is a regular contributor to Medscape.

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