Delivering efficient and affordable IVF coverage to employees 

Support for family building – from fertility benefits to adoption resources to parental leave – is a fast-growing component of employer benefit programs. One of the most notable examples has been the rapid expansion in coverage for In Vitro Fertilization, which assists couples and individuals in conceiving a child. Back in 2019, Mercer’s National Survey of Employer-Sponsored Health Plans found just 22% of large employers (those with 500 or more employees) covered IVF services in their largest medical plan. That figure more than doubled in five years, to 47% in 2024.  

Now an executive order that seeks to address the cost of IVF has further raised the visibilty of this important fertility treatment. While the order does not detail specific plans, policy recommendations on “protecting IVF access and aggressively reducing out-of-pocket and health plan costs for IVF treatment” are due to President Trump by mid-May. The executive order does not require any immediate changes for employer health programs.

Components of cost and efficiency

As we await the policy recommendations, employers that don’t offer IVF coverage – or even those that do but haven’t recently reviewed their benefit design – might find it useful to consider the components of IVF that drive cost and impact affordability. The IVF process involves both complex medical procedures and specialty medications that may not be standard coverages under many employer-sponsored plans. While IVF provides a vital option for many facing infertility, including same-sex couples and individuals wishing to start a family, it is a significant expense, particularly without insurance coverage. Not everyone facing infertility will need IVF, but for those that do, a single cycle of IVF – which may include medication, egg retrieval, fertilization, cryopreservation, testing and embryo transfer – can cost between $25,000-$35,000. Those going through IVF often require two cycles to achieve success.

While it is still most common to cover IVF through the medical plan, employers also have the option to carve this coverage out to one of the many vendors that now provide specialized fertility benefit administration, network management, and access to advocates and clinical resources. These vendor solutions are designed to manage the cost of the care being delivered, educate those receiving the care, and help ensure optimal care outcomes.

Whether working with a medical plan or specialty vendor, there are several important considerations in designing a benefit:

• Benefit limitations Given the high cost of fertility service, nearly all employer health plans include lifetime benefit limitations to put parameters around the cost to the plan. These are typically dollar-based limitations (used by 54% of large employers providing IVF coverage) or limits on the number of cycles covered (used by 23%). Given the variability in the specific services that a member may require, cycle-based designs offer members the flexibility to access clinically relevant services as needed without risking running out of coverage mid-cycle. According to our survey, the median number of cycles covered is three. Conversely, dollar-based designs allow for employers to more accurately budget for their program costs while still providing access to care. The median lifetime dollar limit is $20,000, which falls short of the typical cost for a single IVF cycle.
• Pharmacy costs Specialty pharmacy costs related to IVF can account for a significant portion of the total cycle cost, sometimes as much as 40%. Coverage for these medications can be provided either through an employer’s pharmacy plan or carved out to a specialty fertility vendor. Regardless of the administration method, it is important for employers to understand what may drive variability in their fertility pharmacy costs, such as rebates, discounts and waste management practices. These variables can impact the extent to which the lifetime benefit maximum covers the total cost of treatment.
• Quality of care Perhaps most importantly, employers must consider the quality of the care that members can access. High-quality care, with providers that follow evidence-based medicine to develop clinically relevant, individualized treatment plans, may help members achieve their desired outcome more quickly with the fertility coverage available – while also minimizing the risk of downstream costs for complex newborn care. While a medical plan network may include quality providers, specialty fertility vendors often function as centers of excellence, developing exclusive fertility provider networks that measure cost and quality of care delivered and providing care navigation within the network. Some vendors achieve outcomes that outpace national averages for clinical metrics reported by the Society for Assisted Reproductive Technology.

Opportunity for employers to offer an efficient, effective, and supportive benefit

For employers considering adding or enhancing fertility benefit design, here are a few guiding principles:

•  Aim to offer at least a full cycle of care, whether through a dollar-based or cycle-based benefit design
• Provide equitable access to comprehensive fertility coverage
• Ensure members are accessing high-quality care

Access to fertility benefits can dramatically impact the lives of your employees and strengthen your overall benefits offering. However, these benefits need appropriate structure. With careful design and monitoring, your organization can deliver efficient, clinically-driven, inclusive access to fertility services – with life-changing outcomes for employees.