Aetna expanding, simplifying access to fertility services

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CVS Health subsidiary Aetna has started intrauterine insemination (IUI) as a medical benefit for eligible plans. Members can now access this benefit as a test of fertility and, in some cases, to increase the chances of pregnancy.

Aetna claims it's the first major insurer to update this coverage policy nationally, adding it hopes to increase access to "family-building possibilities."

"This industry-leading policy change is a stake in the ground, reflecting Aetna's support of all who need to use this benefit as a preliminary step in building their family," said Dr. Cathay Moffitt, senior vice president and Aetna chief medical officer at CVS.

WHAT'S THE IMPACT

Aetna said its clinical expert team updates and assesses clinical policies on an ongoing basis to ensure they reflect the latest understandings and guidelines. Across the industry, coverage of IUI services typically has applied to people who purchased separate infertility benefit coverage and could demonstrate an infertility diagnosis.

The updated coverage policy begins nationwide on Sept. 1 for many plans and will be effective on a rolling basis for most plans on renewal. Aetna plan sponsors do not need to make changes, as this is a policy change for eligible medical plans. As a standard process, self-funded plan sponsors may modify their coverage of any benefit, including infertility.

Aetna said it expects women from a number of different communities will benefit from the change.

"We know firsthand the barriers people face in accessing needed medical care to start or grow their families," said Kate Steinle, chief clinical officer for FOLX, a national healthcare provider for the LGBTQ+ community. "As an in-network provider focused on the LGBTQ+ community, we applaud Aetna's efforts to reduce out-of-pocket costs, so that more people can have the families they dream of – and deserve."

THE LARGER TREND

Parent company CVS and its philanthropic arm, the CVS Health Foundation, awarded $6.6 million in grants last year to remove barriers to maternal health services and expand the doula workforce.

The year prior, the U.S. Department of Health and Human Services invested about $20 million to reduce disparities in maternal and birth outcomes. The funding was meant to expand and diversify the workforce caring for pregnant and postpartum individuals, increase access to obstetrics care in rural communities, and support states in tackling inequities in maternal and infant health.

A study in Health Affairs published in 2023 found that understanding the disparities faced by various racial and ethnic groups is key to addressing preterm births and low birth rates, which should spur action from payers, providers and lawmakers.

Various entities have placed a spotlight on maternal health, including the Blue Cross Blue Shield Association, which earlier this year kicked off an effort to reduce ethnic and racial disparities in maternity care in about 600 acute care and pediatric hospitals across the country.

Uber Health, a healthcare-focused subsidiary of the ride-sharing platform, also got in on the action this year, collaborating with the Georgia Primary Care Association and Amerigroup Georgia, a managed care plan and subsidiary of Elevance Health, in an effort to strengthen maternal health in the state.
 

Jeff Lagasse is editor of Healthcare Finance News.
Email: jlagasse@himss.org
Healthcare Finance News is a HIMSS Media publication.