Impacts of Quebec's fertility coverage to private drug plans

Recent announcement by Quebec government to fund in vitro fertilization raises questions on immediate and long-term implications to couples, employers and Quebecers

MONTREAL, July 19 /CNW/ - A recent announcement by the Quebec government to start funding in vitro fertilization (IVF) as of August 5, 2010 will effectively make that province the first jurisdiction in North America to offer such health coverage. However, prescription drugs required for IVF may well mean an increase to private drug insurance premiums by 1.5 per cent.

Aon issued a Special Ready report (www.aon.ca/pubs/RDY/10/jul/SR_QUivf.pdf) that examines the full context behind this recent development and outlines key considerations when opting to resort to this coverage.

The price of fertility treatment

The Quebec government will make it eligible for couples to have from up to three to six cycles of treatment including egg harvesting, IVF, pre-implant genetic testing, embryo transfer and sperm sample collection. Depending on the type of treatment, an IVF cycle can cost between $7,000 to $15,000, including drug costs.

An approximation to cover 3,500 cycles in 2010 is feared to be an underestimated number, while costs are expected to increase in the next three years. It also remains unclear how private drug plans will manage coverage limits, and plan sponsors are urged to remain cautious by requesting carriers and pharmacy benefit managers (PBMs) to implement controls.

Managing expectations

In March, initial drafts of the Règlement sur les activités cliniques en matière de procréation assistée and the Règlement modifiant le Règlement d'application de la Loi sur l'assurance maladie mentioned that studies to date had identified no impact to citizens and businesses, particularly small and medium size organizations.

However, fertility drugs were previously excluded from the Régime général d'assurance médicaments (RGAM) and from most private drug plans. "Adding fertility drugs to the mandatory list when they were generally excluded from private plans or were subject to a cap will definitely have a negative impact on drug insurance premiums," notes Johanne Brosseau, senior consultant at Aon's Montreal office.

Quebecers and employers

Given the current economic climate, Brosseau wonders if "the government's decision takes into consideration the fact that employers pick up 50% of drug costs in Quebec." And what of businesses with a national presence? How will they approach and handle this development within their health and benefits programs?"

It will be more challenging for carriers to manage three- to six-cycle limits than to impose lifetime dollar maximums applicable to both employee and spouse. "I also wonder if the Canadian Life and Health Insurance Association (CLHIA) were invited to discuss these parameters prior to adoption to make sure this would be manageable for private plans," adds Brosseau.

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For further information: Media Contact: Autom Tagsa, 416-542-5659, [email protected]; Marilynne Madigan, 416-230-9699