Readout: AFP’s Texas Policy Forum

Readout: Alliance for Fertility Preservation’s Texas Policy Forum
April 17, 2024
Houston, Texas

Texas State Representative Ann Johnson welcomed attendees and thanked everyone for their
advocacy around HB 1649 last session. She urged everyone who cares about fertility
preservation to continue speaking out as coverage takes hold and offered to help on HB 1649
implementation moving forward.

Alliance for Fertility Preservation (AFP) executive director Joyce Reinecke provided an overview
of the national fertility preservation coverage landscape, including lessons learned from other
states that have passed mandate legislation in recent years. Sixteen states, the District of
Columbia, the Federal Employees Health Benefit Plan and the Veterans Health Administration
all have enacted some form of fertility preservation coverage for their insureds.

Attendees heard a video message from lead bill author Representative Angie Chen Button
expressing pride in the passage of HB 1649 and appreciation for the support of advocates
across the state.

Chris Britton from GovExperts provided detail on the specifics of the coverage required by the
passage of HB 1649. Covered fertility preservation procedures include the collection and
preservation of sperm, unfertilized oocytes, and ovarian tissue for cancer patients. He also
identified the policies affected by the bill —individual, small and large group commercial
insurance regulated by the Texas Department of Insurance, representing 17 percent of the
state health insurance market or approximately 5-6 million Texans.

After the presentations, audience questions led to a discussion about those at risk of iatrogenic
infertility who are not covered by HB 1649, including sickle cell, thalassemia, aplastic anemia
and transgender patients and how to ensure those who lack the benefit aren’t left behind.

Next, Joyce Reinecke moderated a conversation with an expert panel that included Dr. Terri
Woodard from MD Anderson Cancer Center, Stephanie Lawrence from UT Southwestern
Moncrief Cancer Institute in Fort Worth and Amanda Rice, founder of Chick Mission, a nonprofit
that provides grants to cancer patients who want to preserve their fertility. Panelists indicated
that they are dedicated to their work in this field, but feel that the out-of-pocket costs are the
most significant barrier for patients and the hardest part of this work.

Panelists have seen some increased access since HB 1649 went into effect on January 1, but
overall, the outcome has been mixed. There is a general sense that the passage of the law was
a positive development, but most working in the clinics and billing departments aren’t exactly
sure what it all means. Many are still trying to better understand which health insurance plans
are impacted and there is even less knowledge about the bill in community cancer centers
compared to academic medical centers.

Most financial counselors don’t have the capacity to do patient appeals and there is often a
disconnect between the clinicians and the financial counselors. It’s a difficult process that is
very time intensive and unfortunately the burden often lies with the patients who are also
dealing with a cancer diagnosis. There was consensus about the need to ensure that charity
program grant dollars are only used for patients who don’t have insurance coverage and to
hold insurers required to offer the benefit accountable for coverage. A commitment to share
tools and resources was identified as a priority, including template letters, insurance code best
practices and a database of plan benefit designs and clinical guidelines.

Panelists encouraged attendees to continue to stay engaged because there is still a lot of work
to do, including addressing coverage gaps like for those with aplastic anemia and sickle cell. For
self-funded plans outside of the scope of this law, advocates can make the case to their own
employers about the need to provide benefit. Other ideas were suggested, including working
on patient appeals with pro bono attorneys at large law firms and health law clinics at law

Forum participants included individual patients and representatives from:
Alliance for Fertility Preservation
Baylor College of Medicine
CCRM Fertility
Chick Mission
Flatwater Foundation
Houston Assisted Reproductive Technologies
Leukemia & Lymphoma Society
MD Anderson Cancer Center
The Rose
Rutledge Cancer Foundation
Shady Grove Fertility Houston
Texas Children’s Hospital
University of Texas Medical Branch, Galveston
UT Southwestern Medical Center Dallas
UT Southwestern Moncrief Cancer Institute in Fort Worth