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Objectives We aimed to examine the extent to which health plan expenditures for infertility services differed by whether women resided in states with mandates requiring coverage of such services and by whether coverage was provided through a self-insured plan subject to state mandates versus fully-insured health plans subject only to federal regulation. Methods This retrospective cohort study used individual-level, de-identified health insurance claims data. We included women 19-45 years of age who were continuously enrolled during 2011 and classified them into three mutually exclusive groups based on highest treatment intensity: in vitro fertilization (IVF), intrauterine insemination (IUI), or ovulation-inducing (OI) medications. Using generalized linear models, we estimated adjusted annual mean, aggregate, and per member per month (PMPM) expenditures among women in states with an infertility insurance mandate and those in states without a mandate, stratified by enrollment in a fully-insured or self-insured health plan. Results Of the 6,006,017 women continuously enrolled during 2011, 9199 (0.15%) had claims for IVF, 10,112 (0.17%) had claims for IUI, and 23,739 (0.40%) had claims for OI medications. Among women enrolled in fully insured plans, PMPM expenditures for infertility treatment were 3.1 times higher for those living in states with a mandate compared with states without a mandate. Among women enrolled in self-insured plans, PMPM infertility treatment expenditures were 1.2 times higher for mandate versus non-mandate states. Conclusions for Practice Recorded infertility treatment expenditures were higher in states with insurance reimbursement mandates versus those without mandates, with most of the difference in expenditures incurred by fully-insured plans.

Objective: To analyze the perceived impact of insurance coverage for fertility medications on patients' fertility treatment decision-making., Methods: We conducted a cross-sectional study involving a patient survey and chart review of women at a Canadian university-affiliated fertility centre. The primary outcome was to determine whether women with self-reported insurance coverage for fertility medications perceived the impact of insurance coverage for fertility medications differently from women without coverage or those who do not know their extent of coverage. Secondary outcomes included differences between groups in the perceived impact of insurance coverage for fertility medications on specific treatment decisions and the type of fertility treatments undergone by patients. Data collected from the survey and chart review were analyzed using chi-square tests., Results: More women without insurance ranked insurance coverage as having a large impact on the decision to undergo fertility treatment than women in the other groups, although this was not statistically significant. Significantly more women without insurance coverage ranked all specific treatment decisions except for the number of IVF cycles as having a large impact than did women in the other groups., Conclusion: Women perceive that having insurance coverage for fertility medications affects the decision to undergo fertility treatment. Women without insurance are more likely to perceive that insurance coverage affects specific fertility treatment decisions than women with insurance or women who do not know whether they have insurance.

Partial budget analysis was used to determine the economic outcome of estrus synchronization (ES) and timed artificial insemination (TAI) in commercial cow-calf production. Suckled beef cows (n = 1,197) from 8 locations were assigned randomly within each location to 1 of 2 treatment groups: 1) cows were inseminated artificially after synchronization of ovulation using the CO-Synch + CIDR protocol, which includes a 100-μg injection of GnRH (OvaCyst; TevaAnimal Health, St. Joseph, MO) when a controlled internal drug-releasing device (CIDR; Pfizer Animal Health, New York, NY) containing 1.38 g of progesterone was inserted. The CIDR was removed 7 d later, and cows received a 25-mg injection of PGF(2α) (PGF; Lutalyse; Pfizer Animal Health), followed in 66 h with TAI and a second 100-μg injection of GnRH (TAI; n = 582), and 2) cows were exposed to natural service (NS) without estrous synchronization (Control; n = 615). Within each herd, cows from both treatments were maintained together in similar pastures and were exposed to bulls 12 h after the last cow in the TAI treatment was inseminated. Overall, the percentage of cows exposed to treatments that subsequently weaned a calf was greater (P < 0.05) for TAI (84%) than Control (78%) cows. In addition, survival analysis demonstrated that cumulative calving distribution differed (P < 0.05) between the TAI and Control treatments. Weaning weights per cow exposed to treatments were greater (P < 0.01) for cows in the TAI treatment (193.4 ± 4.3 kg) than those cows in the Control treatment (175.9 ± 4.3 kg). Overall, increased returns plus decreased costs ($82.32) minus decreased returns plus increased costs ($33.18) resulted in a $49.14 advantage per exposed cow in the TAI treatment compared with the Control treatment. Location greatly influenced weaned calf weights, which may have been a result of differing management, nutrition, genetic selection, production goals, and environments. We concluded that ES and TAI had a positive economic impact on subsequent weaning weights of exposed cows.