Pubdate: Mon, 11 Sep 2000
Source: Register-Guard, The (OR)
Copyright: 2000 The Register-Guard
Contact:  PO Box 10188, Eugene, OR 97440-2188
Website: http://www.registerguard.com/
Author: Alissa Rubin, Aaron Zitner

COST OF FERTILITY DRUGS SPAWNS BLACK MARKET

WASHINGTON - As increasing numbers of women seek treatment for infertility, 
the combination of sky-high costs and skimpy insurance coverage has created 
a thriving underground market in patient-to-patient drug sales.

According to knowledgeable participants, thousands of individual women and 
couples are obtaining fertility drugs at discount prices from other 
patients who bought more of the medications than they needed.

Buyers and sellers typically meet on the Internet, either directly or with 
the assistance of informal fertility drug brokers who provide their 
services at no cost. They sometimes meet in doctors' offices and 
infertility clinics, some of which allow patients to post notices of drugs 
for sale.

Drug sales between patients are illegal, federal and state authorities say, 
and carry penalties in some states that include jail time. But so far 
authorities have not monitored them aggressively, leaving women relatively 
free to buy and sell leftover fertility drugs without fear of prosecution.

For many women, the incentives are huge. The cost of the most effective 
treatment - in vitro fertilization - is about $10,000, and often several 
rounds of treatment are needed before a woman gets pregnant. The drugs used 
in the process add anywhere from $1,500 to $4,000 to the cost of each 
round. And only about 15 percent of insurance plans cover in vitro 
fertilization, forcing most patients to pay the entire bill.

The high cost can be a formidable hurdle. But fertility decreases with age 
and, if people delay, they might lose the chance to have a child.

Ann, a 39-year-old New Yorker who asked that her full name not be used, has 
been trying to get pregnant for more than three years. But time and money 
are running out. Now that her limited insurance coverage has been 
exhausted, the cost is beyond her means, she said. So, a few weeks ago, as 
she prepared to start her first in vitro fertilization treatment, she 
logged on to the Internet in search of discounted drugs.

Many of the sites primarily serve as support groups for women going through 
the often traumatic cycle of infertility treatments.

Tom McGinnis, director of pharmacy affairs at the Food and Drug 
Administration, said that the FDA is aware of the underground market and is 
attempting to monitor the trade in leftover fertility drugs.

"We are concerned about it," he said.

Buyers who get the drugs from unconventional sources lack the usual 
guarantees that the drugs will be pure and have been handled and stored 
correctly, McGinnis said.

But he acknowledged that the FDA has received no reports of anyone becoming 
sick from drugs bought over the Internet.

In vitro fertilization involves stimulating a woman with hormones to 
produce as many eggs as possible, then removing the eggs and fertilizing 
them with the husband's sperm to obtain a viable embryo that is placed in 
the woman's womb. Like most participants in the underground market, Ann had 
received a prescription from her doctor for the hormone-based drugs needed 
to boost her egg production.

"It's a sin, what we've been going through," she said. "The expense, 
everything about it, is horrible. Why shouldn't it be covered? (Insurance 
companies) cover Viagra."

Among infertility patients, in fact, the lack of insurance coverage is 
causing growing resentment. Many patients believe that insurers avoid 
covering their fertility problems in part because the public views assisted 
pregnancy as an elective procedure, closer to cosmetic surgery than to 
chemotherapy.

"What's happened is that people are just disgusted," said Melissa, a 
Pennsylvania woman who said that she has matched 250 fertility drug buyers 
and sellers via e-mail over the last couple of years, and who asked that 
her last name not be printed. "If you have heart disease, they won't tell 
you you can't have bypass surgery. But for women with no Fallopian tubes, 
they say something else."

"No middle class person can afford this," said Mark Hansen, an emergency 
room nurse in Omaha, Neb. "We couldn't afford it. We had to take out 
personal loans." Hansen and his wife bought fertility drugs, then recouped 
some of the cost of their own treatment by selling some of the drugs they 
did not use to other patients.

The trade in fertility drugs differs from most illicit drug trafficking 
because the profit motive is missing. Buyers and sellers typically talk to 
each other extensively. Many women say the discussions help reassure them 
that they will get the drugs they need and will not be bilked.

Kathryn, a 41-year-old Los Angeles woman, saw a notice posted in her 
doctor's office by another woman who had fertility drugs for sale. At 
first, she and her husband felt like they were "going on an illicit drug 
deal." But when they met the seller, they learned that she had traveled the 
same difficult road in attempting to have a child.

"We clicked instantly," said Kathryn, who requested that her last name not 
be printed. "It was so good to talk to someone about all the frustrations 
of trying to get pregnant. ... It's so devastating, you feel so empty when 
it fails. There's so much hope involved and there's ... the exorbitant costs."

"Our insurance didn't cover anything," said Ellen Dunne, a 30-year-old 
Texas woman who underwent five years of unsuccessful fertility treatment, 
including two cycles of in vitro fertilization. "It was terribly expensive 
for us, and when I called to pharmacies here the drugs were going to cost 
$60 an ampul and I needed four ampuls a day."

Dunne searched on the Internet and found pharmacies in London and Paris 
where she was able to buy the drugs for one-third to half the price charged 
in the United States.

The demand for infertility treatment and the risks some women are taking to 
obtain it have spurred a movement to mandate insurance coverage.

While 13 states require insurers to make some form of coverage available, 
only Massachusetts and Illinois require comprehensive coverage.

One measure pending in Congress would require coverage by the federal 
government's employee health plan. Another would require all insurers to 
offer coverage for infertility treatments deemed "nonexperimental."

Insurers generally oppose mandates, insisting that they would increase 
premiums and cause some people to drop coverage altogether.

"We believe that employers and unions should be able to construct benefit 
packages to meet the needs of people that they're providing coverage for," 
said Susan Pisano, a spokeswoman for the American Association of Health 
Plans, which represents about 1,000 plans nationwide.

There is disagreement over whether mandated coverage would make a 
significant difference in the cost of insurance. Blue Cross in 
Massachusetts said that comprehensive coverage of infertility adds $13.20 
per year to each of its enrollees' premium costs. But until more people 
have such coverage, interest in the underground market is certain to grow, 
participants predicted.
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MAP posted-by: Larry Stevens