Aetna, the insurance arm of CVS Health, announced Tuesday that it will begin covering intrauterine insemination (IUI) as a medical benefit for eligible plans. The payer claims to be the first major insurer to update this coverage policy nationally.
IUI is an artificial fertility treatment in which sperm is injected directly into the uterus, according to Cleveland Clinic. It is most often used for those who have unexplained infertility (or when the doctor can’t find a cause) or mild male factor infertility. It has an individual success rate of 15% to 20%, and it is often recommended to go through three to four rounds of IUI. IUI is considered less expensive than in vitro fertilization, another fertility treatment, and is less invasive. Therefore, it’s often recommended as a first step.
Aetna’s updated policy goes into effect nationally September 1 for several plans and will be “effective on a rolling basis for most plans on renewal,” according to the announcement. Aetna plan sponsors don’t have to make any changes, and self-funded plan sponsors can modify their coverage to include the benefit. The insurer has about 39 million members, according to its website.
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Members can use this benefit to assess their fertility and to improve the chances of pregnancy. It also supports patients regardless of their sexual orientation or partner status.
“By changing this policy, Aetna is ensuring our coverage policy reflects the needs of the diverse members we serve,” said Cathy Moffitt, MD, senior vice president and Aetna chief medical officer at CVS Health, in an email. “We recognize that different individuals need to build families in diverse ways. This also highlights Aetna’s commitment to allyship with all women and people who are looking to build their family beginning with the evaluation of infertility.”
Aetna said its team of clinical experts regularly updates and assesses its clinical policies. Currently, IUI coverage usually applies to those who purchase separate infertility benefit coverage and those who can prove an infertility diagnosis, according to the announcement.
Approximately 9% of men and 11% of women of reproductive age in the U.S. experience infertility. Among LGBTQ+ individuals, a survey by the fertility company Progyny found a high demand for family-building support, though they encounter challenges such as limited access to care and financial constraints.
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FOLX Health, an LGBTQ+ digital health provider that is in network with Aetna, came out in support of Aetna’s decision to expand fertility coverage.
“We know firsthand the barriers people face in accessing needed medical care to start or grow their families,” said Kate Steinle, chief clinical officer of FOLX health, in a statement. “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.”
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