LEGISLATIVE FISCAL ESTIMATE
[First Reprint]
ASSEMBLY, No. 4027
STATE OF NEW JERSEY
221st LEGISLATURE
DATED: JANUARY 28, 2025
SUMMARY
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Synopsis: |
Requires health insurance coverage of preimplantation genetic testing with in vitro fertilization under certain conditions. |
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Type of Impact: |
Annual State and local government expenditure increases. |
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Agencies Affected: |
Division of Pensions and Benefits in the Department of the Treasury; Department of Banking and Insurance. |
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Office of Legislative Services Estimate |
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Fiscal Impact |
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Annual |
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State Expenditure Increase for SHBP |
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$248,000 to $1.3 million |
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Local Expenditure Increase for SEHBP/SHBP |
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$310,000 to $1.7 million |
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Total Expenditure Increase |
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$558,000 to $3.0 million |
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· The Office of Legislative Services (OLS) estimates that requiring health insurance coverage of preimplantation genetic testing with in vitro fertilization under certain conditions will result in a total annual increase of $558,000 to $3.0 million in State and local government expenditures. The OLS notes that the costs may be higher if the State Health Benefits Program and the School Employees’ Health Benefits Program cover more than one test per cycle of in vitro fertilization.
· For reference, the OLS notes that there are currently three types of preimplantation genetic testing available. These are the PGT-A, PGT-SR, and PGT-M tests, each of which varies in purpose, as well as cost per cycle of in vitro fertilization.
BILL DESCRIPTION
This bill requires health insurance coverage of preimplantation genetic testing with in vitro fertilization under certain conditions.
Under this bill, the State Health Benefits Commission and the School Employees’ Health Benefits Commission would be required to provide coverage for preimplantation genetic testing, including in vitro fertilization, where the covered person is not infertile for the purpose of preventing certain serious genetic conditions from being passed to offspring. The commissions may limit the coverage of preimplantation genetic testing to covered persons where (1) both partners are known carriers of an autosomal recessive disorder; (2) one partner is a known carrier of a single gene autosomal recessive disorder and the partners have one offspring that has been diagnosed with that recessive disorder; (3) one partner is a known carrier of a single gene autosomal disorder; (4) one partner is a known carrier of a single X-linked disorder; and (5) the genetic condition, if passed on to the covered persons’ offspring, would result in significant health problems or severe disability. The bill would require coverage for preimplantation genetic testing to be provided at the same extent as for any other health care services under the contract. These requirements would also apply to medical service corporation contracts, health service corporation contracts, group health insurance policies, and health maintenance organization contracts.
FISCAL ANALYSIS
EXECUTIVE BRANCH
None received.
OFFICE OF LEGISLATIVE SERVICES
The OLS estimates that requiring the State Health Benefits Program and the School Employees’ Health Benefits Program to provide health insurance coverage of preimplantation genetic testing with in vitro fertilization under certain conditions will annually increase State expenditures by $248,000 to $1.3 million and local government expenditures by $310,000 to $1.7 million, for a combined total annual expenditure increase of $558,000 to $3.0 million. The OLS notes that the costs may be higher if more than one test is conducted during in vitro fertilization and if more than one test is covered by the State Health Benefits Program and the School Employees’ Health Benefits Program.
Current trends indicate that about five percent of births in New Jersey utilize in vitro fertilization. Out of the births that were conceived via in vitro fertilization nationwide, about 44 percent utilized preimplantation genetic testing. Both of these factors lead to an annual average of 248 births that require preimplantation genetic testing to be covered by the State Health Benefits Program and the School Employees’ Health Benefits Program. The State Health Benefits Program is estimated to provide coverage for 166 births utilizing preimplantation genetic testing, with 110 births covered by the State part and 56 births being covered by the local part. The School Employees’ Health Benefits Program is estimated to provide coverage for 82 births utilizing preimplantation genetic testing.
The OLS notes that there are currently three types of preimplantation genetic testing available: PGT-A, PGT-SR, and PGT-M. Each type of preimplantation genetic test varies in purpose, as well as cost. Under the bill, the State Health Benefits Program and the School Employees’ Health Benefits Program are required, at a minimum, to provide coverage of preimplantation genetic testing to covered persons where (1) both partners are known carriers of an autosomal recessive disorder; (2) one partner is a known carrier of a single gene autosomal recessive disorder and the partners have one offspring that has been diagnosed with that recessive disorder; (3) one partner is a known carrier of a single gene autosomal disorder; (4) one partner is a known carrier of a single X-linked disorder; and (5) the genetic condition, if passed on to the covered persons’ offspring, would result in significant health problems or severe disability. Based on the scenarios outlined in the bill for which coverage must be provided and OLS research, it appears that such scenarios typically lead to the PGT-M test being conducted during in vitro fertilization. Also based on its research, the OLS notes the average cost of the PGT-M test ranges from $7,000 to $12,000 per cycle, while the average cost of the PGT-A test ranges from $2,250 to $4,000 per cycle, and the average cost of the PGT-SR test ranges from $5,000 to $7,000 per cycle. The table below illustrates the estimated costs of each type of preimplantation genetic test by State-administered benefit program:
Currently, the State Health Benefits Program and the School Employees’ Health Benefit Program do not provide coverage for preimplantation genetic testing. The OLS does not know the exact extent to which the programs will cover preimplantation genetic testing, as this will depend on decisions made by the State Health Benefits Commission and the School Employees’ Health Benefits Commission. Factors such as whether the benefit programs will provide coverage for more than one type of preimplantation genetic test per cycle and whether there will be a monetary limit to coverage related to preimplantation genetic testing will impact costs for the State and participating local governments.
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Section: |
State Government |
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Analyst: |
Assistant Fiscal Analyst |
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Approved: |
Thomas Koenig Legislative Budget and Finance Officer |
This legislative fiscal estimate has been produced by the Office of Legislative Services due to the failure of the Executive Branch to respond to our request for a fiscal note.
This fiscal estimate has been prepared pursuant to P.L.1980, c.67 (C.52:13B-6 et seq.).