McMenamin Sara B, Kaiser Bonnie N, Flores Ortega Ricardo E, Yoeun Sara W, Economou Melina A, Bisarya Natasha, Goldman Kara N, Levine Jennifer, Schattman Glenn L, Aarons Gregory A, Romero Sally A D, Su H Irene
Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla.
Department of Anthropology and Global Health Program, University of California, San Diego, La Jolla.
JAMA Health Forum. 2025 Sep 5;6(9):e253166. doi: 10.1001/jamahealthforum.2025.3166.
More than 90 000 adolescents and young adults are diagnosed with cancer and exposed to treatments that may threaten their future fertility every year. Fertility preservation (FP) services, such as egg, embryo, and sperm freezing, are available to preserve future fertility but are often underused by patients in part due to high cost. Eighteen states and Washington, DC, recently began mandating health insurance coverage for FP services, yet patients and clinicians report difficulty accessing mandated services.
To systematically identify determinants of implementing FP benefit mandates in fertility and oncology clinics to inform intervention development and future public policy.
DESIGN, SETTING, AND PARTICIPANTS: In this mixed-methods study, fertility and oncology clinics from California, Illinois, and New York were selected from the 8 states that had FP benefit mandates in place in 2020 to maximize diversity of the state-level characteristics that may impact mandate implementation. Fertility and oncology clinic representatives (health care clinicians, financial counselors, and other administrative personnel) identified as being the most knowledgeable regarding implementation of FP benefit mandates were interviewed or surveyed using the Exploration, Preparation, Implementation, Sustainment (EPIS) framework. Interviews and surveys were conducted from July 2020 to November 2023, and data were analyzed from September 2022 to June 2024.
Passage of a state-level FP benefit mandate.
Barriers and facilitators to implementing access to FP benefits after mandate passage at clinic and patient levels.
This study included 48 participants from 24 oncology and fertility clinics and 2 fertility pharmacies. Interviews (n = 48) and surveys (n = 17) were used to identify determinants of successful FP benefit mandate implementation. The top 3 barriers identified included (1) time-consuming nature of interactions between clinics and insurers, (2) patients' lack of knowledge on their benefits and how to find them, and (3) holes in coverage and heterogeneity of benefits across health insurance plans. The top 3 facilitators included (1) dedicated clinic financial counselors who guide patients on benefit verification, (2) clearly defined FP benefits in member handbooks, and (3) health insurance plan preexisting in vitro fertilization insurance benefit.
In this study, multiple barriers and facilitators were systematically identified to assist in improving implementation of FP benefit mandates. These findings support policies and intervention development for FP patients and clinics, and future legislative and regulatory efforts aimed at increasing timely access to FP insurance benefits.
每年有超过9万名青少年和青年被诊断患有癌症，并接受可能威胁其未来生育能力的治疗。生育力保存（FP）服务，如卵子、胚胎和精子冷冻，可用于保存未来生育能力，但部分患者因成本高昂而经常未充分利用这些服务。18个州和华盛顿特区最近开始强制要求医疗保险覆盖FP服务，但患者和临床医生报告称难以获得规定的服务。
系统地确定在生育和肿瘤诊所实施FP福利授权的决定因素，为干预措施的制定和未来的公共政策提供参考。
设计、设置和参与者：在这项混合方法研究中，从2020年实施了FP福利授权的8个州中选择了加利福尼亚州、伊利诺伊州和纽约州的生育和肿瘤诊所，以最大限度地增加可能影响授权实施的州级特征的多样性。生育和肿瘤诊所的代表（医疗保健临床医生、财务顾问和其他行政人员）被确定为对FP福利授权实施最了解的人员，并使用探索、准备、实施、维持（EPIS）框架进行访谈或调查。访谈和调查于2020年7月至2023年11月进行，数据分析于2022年9月至2024年6月进行。
州级FP福利授权的通过。
在诊所和患者层面，授权通过后实施FP福利获取的障碍和促进因素。
本研究包括来自24家肿瘤和生育诊所以及2家生育药房的48名参与者。通过访谈（n = 48）和调查（n = 17）来确定成功实施FP福利授权的决定因素。确定的前三大障碍包括：（1）诊所与保险公司之间的互动耗时；（2）患者对其福利以及如何获取福利缺乏了解；（3）保险覆盖范围存在漏洞以及不同医疗保险计划的福利存在异质性。前三大促进因素包括：（1）有专门的诊所财务顾问指导患者进行福利核实；（2）会员手册中明确规定了FP福利；（3）医疗保险计划预先存在体外受精保险福利。
在本研究中，系统地确定了多个障碍和促进因素，以帮助改善FP福利授权的实施。这些发现支持针对FP患者和诊所的政策及干预措施的制定，以及未来旨在增加及时获得FP保险福利的立法和监管努力。
