Decoding White House policy to expand access to fertility & IVF

Understanding the policy shift that's transforming fertility benefit

The federal government negotiated new drug prices with EMD Serono, one of the major manufacturers of fertility medications, that is expected to lower the cost of IVF by thousands of dollars for many Americans as early as January 1st. In addition, the Department of Labor has clarified that fertility benefits can operate more like vision and dental benefits, with flexibility to include a broader range of services that help people achieve healthier pregnancies at lower cost. 

For employers, this represents more than just a policy update. It's an opportunity to expand access to critical healthcare services, control spending, and improve outcomes for employees navigating their fertility journey. This could significantly reduce member out-of-pocket costs if your plan allows members to access this program or if you incorporate it into your pharmacy benefit. Certain states are already making policy changes such as California's SB279 bill, we can expect others to follow. However, realizing these benefits requires thoughtful design and implementation. 

What these changes mean for your organization

The implications of these policy shifts are multifaceted and create tangible opportunities for forward-thinking employers:

Significantly reduced medication costs

IVF medications make up approximately one-third of total fertility treatment costs. With deeper discounts and MFN-aligned pricing on commonly used medications like Gonal-f®, Ovidrel®, and Cetrotide®, employers can materially reduce the cost per IVF cycle. 

FDA Review of newer IVF medications is also expected to be expedited, which would further increase competition and decrease costs further in years to come.

Greater benefit design flexibility

The new legal pathway for standalone fertility benefits removes traditional constraints that tied fertility coverage to comprehensive medical plans. Employers can now offer first-dollar coverage for fertility care, creating a benefit structure that's more accessible and easier for employees to navigate. This flexibility mirrors the successful models used for dental and vision benefits, which employees understand and utilize effectively. Benefits can also be used to ensure both men and women receive proper fertility testing and care, and are supported to conceive naturally when possible.

Evidence-based cost management

Lower medication costs create room for employers to implement evidence-based benefit designs that improve both clinical outcomes and financial predictability. By pairing medication savings with strategic clinic partnerships, navigation services, and quality metrics, employers can achieve better success rates without facing exploding utilization or unmanageable administrative burden.

The implementation challenge: a Maven Clinic guide

While the policy changes create opportunity, they also present implementation challenges. How do employees actually access lower medication prices? How do you ensure quality care while controlling costs? How do you design benefits that are truly inclusive and reflect diverse paths to parenthood?

Coordinated medication access and savings

Maven coordinates channel steering to ensure employees receive the lowest net cost on fertility medications. This includes leveraging existing specialty pharmacy relationships, an expanded network, and direct purchase mechanisms as new federal pharmacy programs become available. Unlike traditional models, Maven doesn't mark up medication costs and passes rebates back to employers, ensuring both employees and organizations receive maximum value.

Maven members receive clear care pathways and benefits information through the Maven app, with a dedicated advocate helping them navigate options and make informed decisions. Behind the scenes, Maven handles prescription validation, price transparency, and logistics including shipping and storage—all without disrupting critical clinical timelines.

Evidence-based clinical navigation

Maven's 24/7 care team includes OB/GYN specialists, reproductive endocrinology and infertility (REI) experts, mental health professionals, and nutritionists, supported by a personal Maven Guide for each member. This integrated approach delivers measurable results:

• Emphasis on people trying to conceive: 30% of fertility members who would have otherwise gone on to IVF are able to conceive naturally with the help of Maven’s fertility coaches
• Higher success rates: Better pre-IVF care and center of excellence (COE) clinic steering lead to higher live-birth rates, fewer cycles needed to achieve pregnancy, and lower miscarriage risk.
• Reduced complications and costs: Emphasis on single-embryo transfer (where clinically appropriate) and steering to high-performing clinics reduces multiple gestations and associated NICU costs.
• Superior member experience: Continuous clinical and emotional support, scheduling assistance, and partner inclusion increase both adherence and satisfaction.

Quality assurance through network management

Not all fertility clinics deliver equivalent outcomes. Maven maintains a high-performing clinic network with rigorous vetting processes and ongoing outcomes management. This ensures employees receive care from providers who meet strict quality and safety standards, while employers gain confidence in the value they're receiving.

Inclusive, turnkey benefit design

Maven provides comprehensive support for benefit implementation, including plan design templates, policy language, and communications that authentically reflect every path to parenthood. This inclusive approach ensures benefits resonate with your entire population, not just those pursuing traditional IVF.

Moving forward: your next steps

The convergence of lower medication costs and expanded benefit design flexibility creates a unique window for employers to meaningfully improve fertility benefits. To best capitalize on these fast-evolving policy changes by 2026, we recommend that you pursue a Maven proposal with a medication pass-through pricing model, including steps to:

• Compare against current PBM fertility drug costs and rebate retention
• Evaluate standalone fertility benefit design (leveraging new federal pathway)
• Pilot with Q1 2026 launch to capture TrumpRx.gov discounts
• Quickly identify how state policies will build on these October announcements

Frequently asked questions about the White House’s latest action on expanding access to fertility care

Why does this federal announcement matter?

‍These changes could lower IVF costs, increase employee access, and create new flexibility in how employers design fertility benefits.

What if my company already offers fertility coverage through Maven?

Maven provides the lowest net cost fertility pharmacy benefit through MavenRx. Through our pass-through model, there are no markups, and all manufacturer rebates and discounts flow directly back to the employer and member. 

How will these new IVF medication savings apply if our company offers MavenRx?

Maven already provides the lowest net cost fertility pharmacy benefit through MavenRx. Through our pass-through model, there are no markups, and all manufacturer rebates and discounts flow directly back to the employer and member.

We are excited that these recent developments at the federal level offer potential opportunities as early as 2026 for our clients and members to realize additional cost savings. We are in active discussions with our pharmacy and pharmaceutical manufacturer partners, including EMD Serono, and will continue to provide updates as we learn more about whether these new prices are relevant to the MavenRx offering. 

What should we tell employees right now?

‍You can share this message directly:

‍“You’ll continue to have access to fertility care, navigation, and coaching through Maven. As new federal guidance and medication savings take effect, we’ll work to integrate these changes into your benefits through Maven if applicable. Our goal is to make fertility care more affordable, inclusive, and easy to navigate.”

What if my company doesn’t yet offer Maven?

‍You can take advantage of these changes by introducing Maven’s Fertility & Family Building program offered directly to employers or via one of our 15+ health plan and PBM partners. Maven makes it simple to start, scale, and manage a benefit that’s inclusive, affordable, and clinically sound, without adding administrative complexity. Maven offers flexible benefit design options. Through all options, you will be able to capture upcoming drug cost savings where applicable.

Here’s how Maven supports you from day one:‍

Turnkey program launch: Maven provides a ready-to-implement fertility and family building benefit, complete with model plan designs, compliance support, communications, and clinical integration.‍

• Medication savings: Maven connects members to the lowest-cost pharmacies and ensures all rebates and discounts flow directly to employers and members.‍
• Expert clinical guidance: Members are supported by Maven’s 24/7 care team (including OB/GYNs, reproductive endocrinologists, mental health providers, and nutritionists) to navigate their options confidently.‍
• Inclusive design: The program is built to support every path to parenthood, from IVF and egg freezing to adoption and surrogacy.‍
• Measurable results: Maven tracks key outcomes like time to pregnancy, live birth rates, NICU risk, and Rx spend, ensuring transparency and demonstrating ROI.

What outcomes can we expect with Maven?

Higher success rates: Maven members have achieved better outcomes with fewer interventions—30% conceive without ART, and among those pursuing treatment, the IVF pregnancy rate is 66%, with an average of just 2.0 cycles to pregnancy. Our emphasis on evidence-based care and high-performing clinics drives 98% singleton pregnancy rates, reducing complications and improving outcomes.

‍Lower overall spend: Through our high-touch approach, Maven delivers an average of $8,200 savings per birth for employers that implement the Maven Managed Benefit and Maternity & Newborn Care programs.

‍Better member experience: Continuous clinical, emotional, and financial support helps members feel confident and cared for. With a personal Care Advocate and 24/7 expert access, Maven improves engagement, retention, and outcomes.