[T]he health care plans under consideration for teachers rely in part on savings from no longer providing coverage for expensive drugs that help couples conceive children.
The new plans mean couples having infertility treatment will have to foot the prescription cost themselves. That may pose financial challenges, at least one doctor says.
The plans will stop covering the drugs regardless of what lawmakers and Gov. Phil Scott decide in their continuing showdown over teacher health benefits. Teachers are scheduled to move to these new plans Jan. 1; what remains under debate is whether copays and premium shares should be negotiated at the state or local level.
“In the end there are some people who can’t afford any of it, and if this is a big change to the bill, I think that’s going to make it even harder,” said Dr. Christine Murray, a reproductive endocrinologist who co-owns Northeastern Reproductive Medicine in Colchester.
The current plans offered through the Vermont Education Health Initiative cover screening to diagnose fertility issues, plus four cycles of fertility drugs that help a woman prepare for in-vitro fertilization.
Laura Soares, the president of VEHI, said the new plans will continue to cover screening and diagnosis of fertility issues, but not fertility drugs. The new plans also will no longer cover erectile dysfunction drugs, such as Viagra and Cialis.
GoodRx, a website that prices prescription drugs, says a typical prescription of Viagra or Cialis starts around $300.
Teachers might see some relief because Viagra is scheduled to have a generic competitor starting in December. The drug manufacturer agreed to let a competitor join the market.
The coverage more closely aligns with plans offered on Vermont Health Connect, according to Blue Cross Blue Shield of Vermont, which administers the VEHI plans. Vermont Health Connect plans also cover infertility screening and diagnosis, but not treatment or prescription drugs.
“I think that that probably will impact their ability to afford it,” said Murray, who opened her practice in 2013. “It becomes significantly more expensive if they have no coverage at all after diagnosis.”
Murray said the practice charges $7,000 for one cycle of in-vitro services, and the drugs are an additional $3,000 to $8,000. “That’s almost as much as the treatment itself, and so it can be really cost-prohibitive,” she said.
Murray said teachers do come into the practice because they are often part of the population she sees — women of reproductive age. She said she and her colleagues saw three teachers this week.
Murray estimated that about 15 percent of the population has an infertility issue, and about one-third of those people will eventually use in-vitro fertilization once. “It’s rare that people have to do multiple cycles of IVF,” she said.
Dartmouth-Hitchcock Medical Center in Lebanon, New Hampshire, is closing its infertility program. That means the other major provider of in-vitro fertilization is the University of Vermont Medical Center in Burlington.
Dr. Elizabeth McGee, the division chief of endocrinology and infertility at the UVM Medical Center, said less than 1 percent of her patients end up needing in-vitro fertilization, because something less invasive is appropriate.
The UVM Medical Center currently charges “just under $7,000” per cycle of in-vitro fertilization, according to McGee.
McGee said the fee the hospital charges covers the entire in-vitro fertilization process, including the expensive prescription drugs. The hospital does not offer a payment plan; Murray said her practice does.
The hospital used to charge $18,000, but McGee said she lowered the price when she started running the division in 2013.
“Some insurance will cover three cycles,” McGee said. “Some only cover one cycle. There’s a lot of variability. In Israel they cover as many cycles as you need to have two children.”