Quebec to cover assisted procreation

The legislation will regulate medical practice in this area and protect the safety of patients by restricting the number of embryos implanted at the same time. All costs related to assisted procreation activities—including the extraction of sperm and ova, in vitro fertilization, and the transfer of embryos—will be covered by the Quebec Health Insurance Plan.

Impact on plan sponsors
According to Mercer, the addition of related prescription drugs to the provincial formulary means that private plans will be required to extend coverage to include these drugs without the limitations or exclusions presently included in their contracts. The company’s research suggests that the typical cost of these drugs per cycle of in vitro fertilization can vary from $2,000 to $5,000 depending on the situation.

“On average, the cost of this legislative modification is expected to be less than a 2% increase to the healthcare premium,” says Mercer. “The financial impact will be felt more as all services are extended outside of Montreal and Quebec City, where they will be initially offered.”

While recent developments in other provinces relating to the cost of generic drugs and their potential impact in Quebec were generally received as good news by employers, Mercer believes this legislative modification is expected to increase drug costs for most employers with employees in Quebec. Employers seeking to define the potential financial impact on their own plans will find that an analysis is often necessary to confirm the exact scope of coverage with respect to the relevant services and drugs.

Further findings:

• Based on Mercer’s national database, approximately 50% of private group insurance plans cover fertility drugs;
• The extent to which other services, such as laboratory expenses, are covered is generally not defined in plan contracts, but depends on administrative practices which are not uniform;
• Expenses covered under private group insurance plans are commonly subject to maximums;
• The additional cost to private plans will depend partly on which drugs will be introduced to the provincial formulary, as those drugs will need to be covered by private group plans, but also on the difference in private plan coverage before and after the modification effective August 5, 2010;
• The significant cost of drugs related to assisted procreation will likely result in an increase in the number of plan members that will attain the annual maximum contribution limit ($963 as of July 1, 2010);
• In many cases, an estimate based on the current utilization rate could be insufficient because utilization will possibly increase as services become available free of charge.

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