A growing trend

More employers are offering comprehensive fertility coverage as a part of an inclusive benefit package, helping to attract and retain top talent.

Evernorth FamilyPathSM streamlines fertility treatments and care, expert fertility providers and proactive patient support in a comprehensive solution that leads to simple, more cost-effective fertility-care decisions.

Watch this video about how the FamilyPath fertility solution can help you deliver better fertility coverage and care.

130%

Increase in the percentage of companies
that added fertility benefits in
2019 compared to 20181

62%

Of employers intend to increase
fertility offerings within 3-5 years2

57%

Of employees are willing to
change jobs for infertility coverage
that includes IVF and egg freezing3

FamilyPath Enables Highly
Valued Fertility Benefits

Fertility coverage can be provided at 1% of your premium or a PMPM admin fee.

Click here to download the executive brief – and stay tuned for our downloadable employee toolkit coming later this year.

FamilyPath offers a comprehensive solution
that is committed to nurturing the future.

FamilyPath will:

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Drive down avoidable costs across medical and pharmacy

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Provide holistic care coordination

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Deliver flexible benefit options

Employees with fertility coverage are more likely to rely on the right treatment paradigm – potentially resulting in 40% savings.4

Calculate your estimated cost of fertility coverage and understand your population’s fertility-related costs without coverage

Nurturing a comprehensive fertility benefit

FamilyPath equips you to offer comprehensive coverage to fit a variety of program needs. Our comprehensive approach includes:

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Medical Benefit
Management

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Pharmacy
Management

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High-Quality Provider
and Lab Networks

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Patient Care
and Support

Click through the insight cards below to review how we’re leveraging our long history of pharmacy and medical expertise to develop powerful, comprehensive and effective fertility care.

Nurturing
Medical Expertise

306,174 total assisted reproductive technology cycles were performed in 20185

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  • Nurturing medical expertise

    Cycle Management

    Fertility patients receive treatment in cycles, and cycle management strategies are critical for helping your employees navigate potentially multiple rounds of appropriate care within their benefits.

    • 306,174 total assisted reproductive technology cycles were performed in 2018, resulting in 81,465 live-born infants1
    • The average chance of taking home a baby with each IVF cycle is 30%2
    1. “ART Success Rates”, Center for Disease Control and Prevention, https://www.cdc.gov/art/artdata/index.html
    2. J. Sager, “What are the 2019 Fertility Statistics I Need to Know About?,” CoFertility, 5 May 2019. [Online]. Available: https://cofertility.com/fertility-statistics-2019/.
  • Nurturing medical expertise

    More effective care

    Our long history of medical drug and service management, utilization management (UM) and clinical policies are key components of overall cycle management. Our clinical expertise includes more than 300 nationally recognized academic and community based, board-certified physicians who guide our processes and inform the most appropriate care.

    For example, our rigorous clinical standards have reduced inappropriate utilization by up to 15% across conditions and services, generating clinical program savings of up to 30%.1

    1. eviCore claims SLA reporting
  • Nurturing medical expertise

    Avoiding outdated standards of care

    Outdated standards of care and ineffective treatments can have a big impact on your budget.

    • Some strategies require patients to go through multiple rounds of IUI before they can move on to IVF – even where clinically the patient isn’t a good candidate for IUI.
    • As of 2018, major insurers still included GIFT and ZIFT for broad coverage in clinical policies – reflecting outdated standards of care.1
    • Endometrial scratching has no significant evidence of benefits, yet it is still widely offered.2
    1. “In vitro fertilization (IVF): a review of 3 decades of clinical innovation and technological advancement” Therapeutics and Clinical Risk Management. Available: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1936357/
    2. “IVF Add-ons: Fact, Fiction, Fake or Fortune?” Journal of Fertilization. Available: https://www.longdom.org/open-access/ivf-addons-fact-fiction-fake-or-fortune.pdf

Nurturing
Pharmacy Expertise

Our 30+ years of pharmacy benefit management experience resulted in nearly $50B in clinical savings for our clients and members in 20196

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  • Nurturing pharmacy expertise

    Streamlining the patient experience

    Where and how your employees get their medications matter – especially when they may need as many as 15 prescriptions in a single cycle to address fertility challenges.

    FamilyPath focuses on three key areas in pharmacy to optimize fertility care: benefit administration, claims management and pharmacy care.

  • Nurturing pharmacy expertise

    Benefit administration

    A managed pharmacy benefit is critical when it comes to fertility care. Express Scripts’ pharmacy management for fertility is integrated alongside medical and network management from eviCore.

    The fertility drugs included on the preferred formulary are selected to provide clinically appropriate drug coverage and the best value.

    1. Express Scripts BOB data.
    2. Commercial DT for plans 2017-2019, 2019 DTR.

The Freedom Fertility
Difference

25+ years of dedicated fertility pharmacy expertise

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  • The Freedom Fertility difference

    Industry Expertise

    Identifying and leveraging pharmacy providers who specialize in fertility is critical to achieve the best possible results and to get the most value from your benefit.

    FamilyPath’s preferred pharmacy, Freedom Fertility, has 25+ years of dedicated fertility expertise delivering care, compassion and peace of mind to employees undergoing time-sensitive and highly customized treatment.

  • The Freedom Fertility difference

    Ensuring timely treatment

    Freedom Fertility compounds 100% of their sterile and non-sterile medications on-site – this is rare for fertility pharmacies, but it helps provide patients with a single medication shipment and results in fewer treatment delays, which is critical when it comes to fertility medications.

    Freedom Fertility leverages the Accredo pharmacy network to supply couriered, same-day medications from nine locations in order to service all patients more efficiently.

    1. Information based on practices of Freedom Fertility pharmacy, January 2020.
    2. 2019 Freedom Fertility Drug Transfer Report.
    3. “How Much Does IVF Really Cost?” Verywell Family. [ONLINE] Available: https://www.verywellfamily.com/how-much-does-ivf-cost-1960212
  • The Freedom Fertility difference

    Avoiding financial waste

    Thanks to Freedom Fertility’s expertise and good-standing relationships with manufacturers, there have been zero out-of-stock drug events during several nationwide drug shortages.

    In these circumstances, Freedom Fertility is able to supply therapy to patients who would otherwise have to cancel treatment – preventing potential financial waste.

Nurturing
Quality Networks

FamilyPath’s network of high-quality providers ensures your employees receive the best care

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  • Nurturing quality networks

    Solving market challenges

    An infertility diagnosis comes with a lot of information to process. With FamilyPath, our network of conveniently located, high-quality providers take the guesswork out of determining where your employees will receive the best care.

    FamilyPath offers the advantage of mature and technology-enabled processes, portals, communications, and dedicated service teams, which allows for a better physician experience and maintains the quality of providers in our network.

  • Nurturing quality networks

    Identifying high-quality providers

    Identifying the most appropriate provider labs and networks is something we’ve excelled in. We maintain competitive rates, use validated processes and have a history of satisfied, high-quality providers.

  • Nurturing quality networks

    Top-of-the-line evaluation

    Fertility patients are high risk, and the chances of becoming pregnant with each cycle can be relatively low. As a result, it’s critical to ensure that your employees have access to top-of-the-line physicians and are being evaluated appropriately.

    In addition, there are complex lab tests required throughout a patient’s journey. Tests can range from standard testing in order to establish the underlying cause of infertility, to embryo testing, which ultimately reduces the risk of adverse pregnancy outcomes.

Nurturing every patient

Fertility care is complex, socially isolating and extremely time sensitive

Your employees are faced with numerous treatment options and providers to choose from, in addition to navigating what is or is not covered by their fertility benefit.

Designed to be personal from the first encounter, a dedicated, fertility-focused support team will be available to your employees as they navigate their treatment, set up doctor’s appointments and begin therapy.

Download this interactive PDF to see how comprehensive coverage can outperform a limited benefit at every step of the patient journey.

Download now
A FamilyPath Fertility Advisor helps patients navigate day-to-day questions and needs:
  • Answers coverage questions about fertility benefits
  • Assists with understanding treatment options
  • Offers digital tools and educational resources
  • Assists in scheduling first appointment with an in-network fertility clinic
  • Connects the patient with clinical team members and the health plan case manager

Nurturing body & mind

FamilyPath identifies patient risk to increase the chance of better outcomes

Body

Women who received fertility treatment are about 40% more likely to experience a severe pregnancy complication, which may lead to higher maternity care and associated NICU costs.7

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FamilyPath’s early detection strategy triggers referrals for care management with the patient’s health plan case management team in order to help keep costs down and resolve potential issues.

Mind

Men and women managing infertility experience a higher level of anxiety compared to the general population. One study found 87% of women seeking fertility care had anxiety and 41% suffered from depression.8

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FamilyPath includes access to behavioral health resources, including Digital Cognitive Behavioral Therapy – which teaches patients to respond differently to day-to-day stressors and triggers that may be associated with their diagnosis.

Provide Comprehensive Coverage

With FamilyPath’s Comprehensive approach you can provide complete fertility coverage, delivering a suite of fertility solutions that ensure your employees will receive the care they need. This approach provides turnkey capabilities for employers and support for patients – enabling employers to retain and attract talent with a comprehensive benefit while reducing fertility and maternal costs.

A Comprehensive approach inludes:

  • Assisted Reproductive Technology (ART), including In-Vitro Fertilization (IVF) and Intrauterine Insemination (IUI), Frozen Embryo Transfer (FET) and Ovulation Induction (OI)
  • High-touch patient engagement with Fertility Advisor assistance
  • Connectivity to other plan services (disease management, high-risk maternity care, behavioral health)

A La Carte Services

Add these referral services to your comprehensive plan:

  • Cryopreservation
  • Surrogacy*
  • Adoption*

Learn more

  • A la carte services

    Cryopreservation

    Includes referral services for harvesting, cryopreservation and storage of sperm, oocytes and embryos in the event that the employee is undergoing treatment that may render them infertile.

    Surrogacy*

    Includes referral services for employees seeking support for surrogacy services, in the event they are unable to conceive due to infertility or without a partner of the opposite sex.

    Adoption*

    Includes referral services for employees seeking support for adoption services when they are unable to conceive due to infertility or without a partner of the opposite sex.

    * Includes a referral to a trusted partner to access services. Payment for services is between the vendor and the employee and outside of the program. Recommend employee seeks legal advice regarding federal rules governing medical dollars and ancillary benefits.
  • What you should know

    While the standard services offered through your Health Plan provide a starting point, they may not be comprehensive enough for your population. Comprehensive fertility coverage allows you to meet your workforce’s changing fertility needs.

    Only 3%

    Of patients seeking fertility services use IVF.1

    73%

    Of millennials would use cryopreservation.2

    4X+

    Surrogacy has increased dramatically since 1999 (for IVF cycles), accounting for over 18K infants born in the U.S.3

    ~135,000

    Adoptions occur in the US each year. Experts estimate between 1-2 million couples may be waiting to adopt.4

    1. “Employers and Evidence-Based Infertility Benefits,” EMDSerono.
    2. “Infertility in America 2015 Survey and Report,” Reproductive Medicine Associates of New Jersey.
    3. “Trends and outcomes of gestational surrogacy in the United States,” Centers for Disease Control and Prevention, Division of Reproductive Health, Atlanta, Georgia. Available: https://www.fertstert.org/article/S0015-0282(16)61057-9/pdf.
    4. “US Adoption Statistics,” Adoption Network. Available: https://adoptionnetwork.com/adoption-statistics.

Nurturing the Future

We will continue evaluating opportunities to improve and expand FamilyPath’s fertility services and support. We’re enhancing a digital patient app and researching additional solutions to help provide broader maternity and women’s health support.

A life-changing solution from Evernorth. Helping to solve the problems others don’t, won’t or can’t.
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CONTACT US TODAY

We are proud to be your trusted partner for better fertility benefits.

Contact us today to learn more about offering fertility benefits through FamilyPath.

Contact Us

We are proud to be your trusted partner for better fertility benefits.