Advance-CTR

Advance-CTR Pilot Projects Program (Cycle 6)

"Utilization of fertility preservation services after implementation of an insurance mandate "

Fertility preservation (FP) procedures (oocyte and embryo cryopreservation) are safe, increase fecundity, and improve quality of life (QoL) in reproductive age cancer survivors. Despite the benefit of these procedures utilization rates are low nationally. The long-term objective of this project is to increase FP consultations and procedures. The research plan to achieve this goal includes first understanding barriers to care and then designing interventions to improve utilization. To begin to understand potential barriers, we propose this research project to determine the impact of cost barriers on FP services by comparing pre and post insurance mandate FP utilization. On July 5th, 2017 Rhode Island was the first state to pass a FP mandate that requires commercial insurance plans to pay for FP procedures prior to gonadotoxic treatment (i.e., chemotherapy and radiation). Our hypothesis is that insurance claims for FP consultations and procedures have increased since the insurance mandate has been in place because cost is one of the predominant barriers to FP procedures in cancer patients. In particular we aim to: Evaluate the impact of the FP coverage mandate on FP consultations, evaluations, and procedures among commercially insured reproductive-aged females in Rhode Island. We will achieve this aim by utilizing the Rhode Island all-payer claims database (APCD) and a time-series design to assess the proportion of female reproductive-aged cancer patients who received FP services before (1/1/2012-7/4/2017) and after (7/5/2017-6/30/2021) the mandate was implemented. We will evaluate patients with commercial insurance and non-commercial insurance coverage (primarily Medicaid which have no coverage for FP procedures) separately.

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