Plans will need a streamlined fertility benefit management solution that provides comprehensive care. Evernorth FamilyPathSM applies our medical and pharmacy expertise to fertility treatments, expert fertility providers and proactive patient support, leading to simple, more cost-effective fertility decisions for plans and members.
Of Health Plans intend to increase their fertility offerings within 3-5 years1
More likely employers will carve out fertility than in previous years2
Watch this video about how the FamilyPath fertility solution can help you deliver better fertility coverage and care.
Fertility coverage can be provided at 1% of your premium or a PMPM admin fee.
Click here to download the executive brief – and stay tuned for our downloadable member toolkit coming later this year.
FamilyPath will:
Drive down avoidable costs across medical and pharmacy
Provide holistic care coordination
Deliver flexible benefit options
Members with fertility coverage are more likely to rely on the right treatment paradigm – potentially resulting in 40% savings.3
Every fertility journey is unique, and what works for one patient may not be the right approach for another. This is why FamilyPath offers flexible options to fit a variety of different plan needs. The FamilyPath fertility solution includes:
Medical Benefit
Management
Pharmacy
Management
High-Quality Provider
and Lab Networks
Patient Care
and Support
Click through the insight cards below to review how we’re leveraging our long history of pharmacy and medical expertise to develop powerful, comprehensive and effective fertility care.
Nurturing
Medical Expertise
306,174 total assisted reproductive technology cycles are performed annually4
Nurturing medical expertise
Our long history of medical drug and service management, utilization management (UM) and clinical policies are key components of overall cycle management. Our clinical expertise includes more than 300 nationally recognized academic and community based, board-certified physicians who guide our processes and inform the most appropriate care.
For example, our rigorous clinical standards have reduced inappropriate utilization by up to 15% across conditions and services, generating clinical program savings of up to 30%.1
Nurturing
Pharmacy Expertise
Our 30+ years of pharmacy benefit management experience resulted in nearly $50B in clinical savings for plans and members in 20195
Nurturing pharmacy expertise
Where and how your members get their medications matter – especially when they may need as many as 15 prescriptions in a single cycle to address fertility challenges.
FamilyPath focuses on three key areas in pharmacy to optimize fertility care: benefit administration, claims management and pharmacy care.
Nurturing pharmacy expertise
A managed pharmacy benefit is critical when it comes to fertility care. Express Scripts’ pharmacy management for fertility is integrated alongside medical and network management from eviCore.
The fertility drugs included on the preferred formulary are selected to provide clinically appropriate drug coverage and the best value.
The Freedom Fertility difference
Identifying and leveraging pharmacy providers who specialize in fertility is critical to achieve the best possible results and to get the most value from your benefit.
FamilyPath’s preferred pharmacy, Freedom Fertility, has 25+ years of dedicated fertility expertise delivering care, compassion and peace of mind to members undergoing time-sensitive and highly customized treatment.
The Freedom Fertility difference
Freedom Fertility compounds 100% of their sterile and non-sterile medications on-site – this is rare for fertility pharmacies, but it helps provide patients with a single medication shipment and results in fewer treatment delays, which is critical when it comes to fertility medications.
Freedom Fertility leverages the Accredo pharmacy network to supply couriered, same-day medications from nine locations in order to service all members more efficiently.
The Freedom Fertility difference
Thanks to Freedom Fertility’s expertise and good-standing relationships with manufacturers, there have been zero out-of-stock drug events during several nationwide drug shortages.
In these circumstances, Freedom Fertility is able to supply therapy to patients who would otherwise have to cancel treatment – preventing potential financial waste.
Nurturing
Quality Networks
FamilyPath’s network of high-quality providers ensures members receive the best care
Nurturing quality networks
An infertility diagnosis comes with a lot of information to process. With FamilyPath, our network of conveniently located, high-quality providers take the guesswork out of determining where your members will receive the best care.
FamilyPath offers the advantage of mature and technology-enabled processes, portals, communications, and dedicated service teams, which allows for a better physician experience and maintains the quality of providers in our network.
Nurturing quality networks
Identifying the most appropriate provider labs and networks is something we’ve excelled in. We maintain competitive rates, use validated processes and have a history of satisfied, high-quality providers.
Nurturing quality networks
Fertility patients are high risk, and the chances of becoming pregnant with each cycle can be relatively low. As a result, it’s critical to ensure that your members have access to top-of-the-line physicians and are being evaluated appropriately.
In addition, there are complex lab tests required throughout a patient’s journey. Tests can range from standard testing in order to establish the underlying cause of infertility, to embryo testing, which ultimately reduces the risk of adverse pregnancy outcomes.
Fertility care is complex, socially isolating and extremely time sensitive
Your members are faced with numerous treatment options and providers to choose from, in addition to navigating what is or is not covered by their fertility benefit. Helping them understand their coverage and ensuring they can access medications and providers in an uncomplicated way is essential.
Designed to be personal from the first encounter, a dedicated, fertility-focused support team will be available to members as they navigate their treatment, set up doctor’s appointments and begin therapy.
Download this interactive PDF to see how comprehensive coverage can outperform a limited benefit at every step of the patient journey.
Download nowFamilyPath identifies patient risk to increase the chance of better outcomes
Women who received fertility treatment are about 40% more likely to experience a severe pregnancy complication, which may lead to higher maternity care and associated NICU costs.6
FamilyPath’s early detection strategy triggers referrals for care management with the patient’s health plan case management team in order to help keep costs down and resolve potential issues.
Men and women managing infertility experience a higher level of anxiety compared to the general population. One study found 87% of women seeking fertility care had anxiety and 41% suffered from depression.7
FamilyPath includes access to behavioral health resources, including Digital Cognitive Behavioral Therapy – which teaches patients to respond differently to day-to-day stressors and triggers that may be associated with their diagnosis.
FamilyPath offers flexible options through two recommended approaches:
For plans that already offer some fertility coverage but would like to implement stronger cost-control levers. This approach offers a starting point in providing more inclusive fertility coverage.
Add these referral services to your Standard plan:
Includes all services offered in Standard
For plans looking for turnkey capabilities within a flexible suite of fertility solutions. This approach allows plans to retain and upsell existing fertility clients — and compete for and win new business while providing a very inclusive, supportive benefit.
Includes all services offered in Standard
Add these referral services to your Comprehensive plan:
We will continue evaluating opportunities to improve and expand FamilyPath’s fertility services and support. We’re enhancing a digital patient app and researching additional solutions to help provide broader maternity and women’s health support.
A life-changing solution from Evernorth. Helping to solve the problems others don’t, won’t or can’t.
What is Evernorth?
We are proud to be your trusted partner for better fertility benefits.
Contact us today to learn more about offering fertility benefits through FamilyPath.
Contact UsWe are proud to be your trusted partner for better fertility benefits.
