4 questions on President Trump and IVF

As part of our “4 questions with” series for Second Opinion VIP subs, I was eager to learn more about President Trump’s recent Executive Order to “expand access to” in vitro fertilization, or IVF.

How significant is it? Is there any real policy heft behind it? And if you’d like to gain access to IVF and can’t afford it, what does this mean for you? To get answers, I pulled aside Joshua Abram, co-founder of Conceivable Life Sciences (and a Scrub Capital portfolio company), to discuss.

Joshua has worked for several decades in the fertility industry, first as cofounder of TMRW Life Sciences, which helps clinics better store frozen eggs and embryos. Conceivable goes even further, by automating the embryology lab, with the goal of improving precision and bringing down the cost of assisted reproduction treatments.

This interview has been edited for brevity.

Second Opinion: What did you make of President Trump’s executive order to expand IVF access? Is there any actual policy behind it?

JA: When the President of the United States tells his Domestic Policy Council to draft a plan within 90 to “protect IVF access and aggressively reduce out-of-pocket and health plan costs for such treatment,” I can only applaud. I think that Trump has conviction on this topic, both on a political and personal level. Is there any real policy associated with this order? No, not yet. But let’s see what his advisors, with a deadline to meet, come up with.

Second Opinion: How much do you see the government here in the U.S. making IVF more affordable? Or is that a state-by-state decision?

JA: State IVF mandates such as the one in Massachusetts, which require insurance companies to offer IVF [when it’s medical necessary] have been wildly successful in driving IVF utilization. Seven percent of all children in Massachusetts are now born via IVF versus the national average of less than 2% [although, as an editors’ note, some policy experts have argued that this mandate is not sufficient and should be expanded to an even broader subset of patients.] If the President’s advisors want to create maximum impact using a proven model, they must consider requiring such mandates on a national level. Indeed, Trump suggested this in passing during the campaign. Obviously, if the feds take this route and require that IVF be part of most insurance plans on a national basis, then the actions of the individual states become far less important.

Second Opinion: Are you seeing insurers take note beyond the large self-insured ones who are looking for ways to retain talent?

JA: IVF coverage has become almost table stakes as an employee benefit at large companies. According to Mercer, fertility treatment is now covered by 47% of all large self-funded employers, up from 45% last year. Of the largest employers, 70% cover IVF. Elective egg freezing and elective sperm freezing are covered by 21% of all large employers. For those consumers who do not have big company coverage, there are innovative startups that are offering plans designed to cover the downside risk of a failed IVF attempt. When IVF is successful, it will turn the ongoing cost into manageable consumer finance-like payments. Gaia and Future Family come to mind, with both companies now rolling out new programs that look increasingly like IVF insurance rather than just IVF financing.

Second Opinion: IVF is cheaper in other countries. What are the major factors, beyond policy changes, to bring down costs in the U.S.?

JA: Here’s what I think the White House Domestic Policy Council will consider over the next 90 days as they prepare a plan for the President.

1. Vastly expand the use of OB-GYNs in the IVF process. 18% of American couples suffer from infertility. There is absolutely no way to address their need for IVF in an affordable and scalable manner if continue to rely on 1300 reproductive endocrinologists (the medical specialists that treat and diagnose infertility) as the only source of care.

2. Make it a federal requirement that health insurance plans provide an IVF benefit. Enough said.

3. Focus on bringing down drug costs. Medications are roughly 25% of the cost of IVF. In America, there are only two FDA-approved suppliers of the key medications used in IVF, in large part because current FDA regulations require crushingly expensive studies to demonstrate safety and efficacy even for IVF drugs that have been used effectively in Europe for decades. Trump acolyte Vivek Ramaswamy has often made this point regarding burdensome FDA approvals requiring drugs with years of safe use in other Western markets. So, I think that could be an area of focus for the White House.

4. Supporting automation and technology. Over the next few years, automation will transform the critical IVF lab from its manual, artisanal, and unscalable present state to becoming a therapy that can be widely offered on a population health basis at an affordable price, whether the cost is borne by third-party payers or consumers directly.

Well, that’s it for this week’s edition of Second Opinion. If you have ideas for a “4 questions with” series, I’m all ears. And I’m curious about what you think? Will this administration walk the walk on expanding affordable access to IVF and other forms of reproductive health treatment? Reach me at [email protected]