Illinois General Assembly passes bills expanding fertility treatment and prescription drug coverage

By

Maddie McCarthy

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Legislative bills expanding healthcare coverage for fertility treatment and prescription drugs were approved by the Illinois General Assembly on Tuesday.

Senate Bill 773, sponsored by Sen. Cristina Castro (D-Elgin), would expand private insurance coverage for infertility treatment.

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SB 773 cosponsor Rep. Margaret Croke (D-Chicago) said the bill removes the four-round cap on in vitro fertilization (IVF) cycles Illinois law currently mandates private insurers to cover. SB 773 would allow families to undergo additional IVF cycles without having to pay out-of-pocket costs, aiming to increase their chances of having a child.

“According to a 2015 study, the live birth rate from a single [IVF] cycle was 30 percent, with similar success rates holding steady for one to four cycles,” Croke said. “The success rate jumps to 65 percent for women who complete six cycles. Some of these numbers change depending on the patient’s age, but this demonstrates how impactful just a few additional cycles of IVF can be in resulting in a live birth.”

SB 773 also requires coverage for an annual menopause visit.

SB 773 applies to group policy health insurance plans covering more than 25 employees that already provide pregnancy-related benefits, Croke said. State employee health insurance plans currently cover this benefit, and SB 773 would not apply to Medicaid.

There is no estimated fiscal impact for SB 773, and the Illinois Life and Health Insurance Council (ILHIC) has indicated a neutral position on the legislation. ILHIC advocates for the protection and growth of a competitive insurance marketplace and supports legislative decisions that give Illinois consumers access to affordable insurance options.

Croke said covering more than four IVF treatments may ultimately save health plans money because they are not paying for the medical costs of pregnancy complications associated with multiple embryo implantation.

“Ultimately what happens when you don’t have adequate IVF coverage is that families make the decision that they’re going to get implanted with multiple embryos,” Croke said. “When you get implanted with multiple embryos, there is an increased chance of multiple births, and when you have multiple births, usually those are premature. You’re talking about twins, triplets. That cost is much more significant than any type of change in coverage.”

An American Journal of Obstetrics and Gynecology study found that a pregnancy resulting in the delivery of twins costs up to five times more than a pregnancy involving a single child. With triplets or more, it can cost up to 20 times more than a single-child pregnancy.

Croke also said that without adequate IVF coverage—uncovered IVF cycles cost up to $30,000 or more—successful fertility treatment is often limited to families who can afford additional rounds of IVF.

“The decision to undergo additional rounds of IVF should be left to a medical provider and his or her patient, and not dictated by financial limitations.”

— Croke

Lawmakers also passed SB 2672, sponsored by Sen. Laura M. Murphy (D-Des Plaines), which would expand coverage for prescription medications by requiring insurers to cover name-brand prescription drugs when the generic is unavailable. 

The bill’s cosponsor, Rep. Terra Costa Howard (D-Lombard), said prescription drug shortages limit a patient’s ability to obtain medication. 

“If the generic drug is unavailable due to a supply issue, and that dosage cannot be readjusted, [SB 2672 says] insurance and managed care plans must cover the brand name—that eligible prescription drug—until the generic brand comes back,” Costa Howard said.

There are no cost estimates attached to the bill, and ILHIC has taken a neutral position on the legislation.

Both SB 773 and SB 2672 await signatures from Gov. J.B. Pritzker for implementation.

Readers can learn more about health-related legislation during the “Legislators Discuss Health Policy” panel at the 2024 Illinois State of Reform Health Policy Conference, which will be held on May 29 at the Fairmont Chicago Millennium Park. Those interested can register here.

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