WIN Fertility provides diagnosis-specific care management of infertility treatment, based on clinical protocols developed by our Medical Advisory Board, consisting of prominent reproductive endocrinologists. The program is designed to produce significant savings by addressing the current inconsistencies in the delivery of infertility care created by the lack of treatment standards in this niche specialty. Total savings related to infertility services as a result of WIN’s comprehensive program can exceed 50%. Without appropriate care management, the result is often the uncontrolled use of hormonal treatment and/or surgical intervention, which are the leading causes of multiple gestations, high-risk pregnancies and complications associated with premature and low birth-weight infants.

WIN’s strategy impacts the total infertility dollar. In many instances pharmaceuticals would not be covered if the member had exhausted the number of clinical procedures allowed under law. Because of WIN’s tremendous impact on decreasing total infertility-related utilization, pharmaceutical unit pricing ends up representing a small part of the total infertility savings generated by the WIN program. Nonetheless, WIN’s infertility pharmaceutical pricing includes savings achieved by combining discount pricing through our national specialty pharmacy network and unit price discounts from manufacturers. By precisely coordinating the patient’s benefits, eligibility, medical history, authorizations, outcomes and claims payments with each of the patient’s prescriptions, WIN maximizes the impact on global infertility pharmaceutical savings. This percentage excludes savings related to prenatal, obstetric, post partum, neonatal and chronic care costs as a result of high order births. The comprehensive infertility program directly impacts these potentially catastrophic costs and is a substantial benefit to the plan. 

Percentage of Infertility Savings (Pharmaceutical vs. Clinical)