Assistance with fertility care, a stated priority of President Trump, is an urgent need for many people. Rarely considered a “medically necessary” health service by health plans, only a minority of employers offer fertility benefits; and IVF is typically never covered by Medicaid or Medicare. The nationally representative KFF Women’s Health Survey finds that one in eight (13%) women ages 18 to 49 say they or their partner needed fertility assistance services at some point. While there are many obstacles to receiving fertility care, cost is by far the single largest barrier. Among those who reported needing fertility services at some point, 12% say they did not receive these services with cost cited as the leading reason.
During the 2024 campaign, Donald Trump pledged to make IVF free, and many have been waiting for the Administration to fulfill this promise. Following an executive order earlier this year, the October 16th White House announcement proposes to offer a discount on certain drugs that are used in IVF treatments through a new government website, TrumpRx.gov, and to develop additional options for employers to voluntarily offer assistance with fertility and family formation costs for their workers and their dependents. The impact of this plan, however, will be limited to either those covered by an employer that opts to cover these benefits or those who will be able to get discounts through the TrumpRx website once it is fully operational in 2026 and who can afford to pay the other costs associated with IVF that are not being made available at lower prices.
What are the features of Trump’s announcement on IVF?
The White House announcement focused on reducing the cost of some IVF drugs and clarifying options for employers to offer standalone fertility benefits for their employees and their dependents. Here are some key takeaways about the Trump IVF plan:
IVF drug costs: The Trump Administration says it will decrease the price of IVF drugs, Gonal-F, Ovidrel, and Cetrotide. People who use TrumpRx.gov will be connected to manufacturers who will sell them the drugs directly. This is based on a deal that the Administration made with the manufacturer, EMD Serono, to provide their medications to patients at Most Favored Nation (MFN) pricing, which would tie drug prices to the lowest price paid in a set of other developed nations. It is difficult to know precisely what the cost savings for IVF drugs specifically will be, both because of uncertainty around exactly what the MFN price level will be, and because the TrumpRx website is not yet operational. CMS estimates that women can save up to $2,200 per cycle of fertility drugs as a result of this deal on drugs that often cost over $5,000. While any reduction in the price of IVF drugs could be helpful, these are just a few of the many drugs that individuals may take throughout their IVF treatment. Gonal-F and Ovidrel are gonadotropins used to stimulate the ovaries and Cetrotide is a GnRH antagonist that prevents premature ovulation. Other medications involved in IVF cycles are oral contraceptive pills to control the timing of the menstrual cycle, as well as drugs that help prepare the uterine lining for implantation, stimulate egg growth, and prevent infections prior to embryo implantation. IVF treatment plans are very individualized to the person and not everyone going through IVF uses these specific discounted drugs. There are currently websites that already offer self-pay patients with discounts on fertility drugs, so the impact of the TrumpRx discount may depend on how it compares to existing discount programs. The White House announcement also states that the FDA will include a lower cost fertility drug in the initial round of recipients for the National Priority Review Voucher program, and that the review timeline will be expedited.
Fertility benefits: The administration states that they have created a new benefit option that makes it easier for employers to offer stand-alone fertility benefits–should they choose to. However, the pathway for these benefits was originally created in 1996 as part of the federal Health Insurance Portability and Accountability Act (HIPAA), which established the categories of “excepted benefits.” The Trump announcement does not create a new benefit category, rather it clarifies by explicitly stating that employers can offer fertility benefits under two subtypes of excepted benefits. Some employers have already been offering standalone fertility benefits without this level of regulatory specificity. In recent years, a number of companies, such as Carrot Fertility, Maven, and Progeny, have been established to offer such a product. Employers who offer comprehensive health insurance can use these programs to extend fertility benefits to their workers using a “group coverage” health reimbursement account (HRA) which allows employers to decide how much they want to spend on these benefits and does not have a federal spending cap. The White House plan clarifies that employers can use the following additional approaches to extend fertility benefits to their workers:
- Independent, non-coordinated excepted benefit: Employers can currently offer standalone benefits for some specific services such as coverage for only a specified disease (such as cancer-only policies) and hospital indemnity insurance. The Trump announcement clarifies employers can voluntarily choose to also offer standalone insured fertility benefits, regardless of whether the employer also offers comprehensive health insurance. The Administration intends to do future rulemaking that would allow employers to offer standalone “self-insured” fertility benefits. A freestanding fertility plan, however, would be of limited utility to people who are currently uninsured for fertility care unless it is offered along with comprehensive insurance that covers prenatal care and other costs associated with childbirth. The range and costs of services that such a plan might cover could be as comprehensive or narrow as the employer defines since it is an optional benefit.
- Limited excepted benefits: These plans include “excepted benefit health reimbursement accounts” (HRAs) that reimburse employees for their out-of-pocket fertility expenses, but employer contributions are capped at $2,150 for these accounts. This could be an option for employers who want to offer fertility benefits but want to limit their financial exposure to this relatively small amount, as it would only cover, on average, one -tenth of the cost of one IVF cycle. This might also include an Employee Assistance Program that provides coaching and navigator services related to fertility benefits. The Trump Administration is proposing future rulemaking to expand the ways employers can provide fertility benefits as limited excepted benefits, but do not outline these options in the announcement.
What will be the impact of Trump’s IVF plan?
While many people are not insured for IVF, without a subsidy, mandate or some type of employer incentive, the President’s proposal is not likely to make a significant dent to the current gaps in access to IVF services, as it essentially offers a discount for a limited set of drugs and clarifies that employers have pathways to offer a limited benefit without running afoul of ACA and HIPAA regulations. For people who lack coverage for IVF services, the discount on drugs through TrumpRx.gov could lower out of pocket costs for people who rely on those drugs as part of their treatment plan, but alone it does not address the majority of IVF costs, such as egg retrieval and embryo transfer.
The President’s announcement also encourages employers to offer IVF and other fertility benefits, but there is no mandate, nor are there any federal subsidies nor new tax incentives to encourage employers to offer these benefits to their workers. To implement a new mandate or tax incentive, Congressional action would be required. Employers already have the option to offer fertility benefits either as part of their insurance plan or as a standalone benefit. The KFF Employer Health Benefits Survey finds that one in four (27%) larger employers (200 or more workers) offers IVF coverage to their workers as do half (53%) of employers with at least 5000 workers. These benefits can vary greatly and may not cover the full cost of an IVF cycle, which on average ranges from $15,000 to $20,000, and many individuals struggling with infertility may need more than one IVF treatment cycle.
Private insurance coverage for IVF has grown over the past decade, particularly as more states have enacted laws requiring plans in their state to cover services. These laws vary widely in scope and who is eligible for benefits. Some are limited to those who have a diagnosis of infertility, which effectively excludes single individuals and same sex couples. The White House announcement does not address any of these limitations. State laws, however, do not apply to self-funded plans, which cover about two-thirds (67%) of workers with employer-based insurance.
The plan also does not address gaps in fertility coverage faced by the nearly 16 million reproductive age women who are currently enrolled in Medicaid. Even with a discount through the TrumpRx website for some medications, the costs of the rest of IVF-related services would be prohibitive for most people on Medicaid who must have a low income to qualify for the program. A 2020 review of Medicaid programs conducted by KFF found that the vast majority of state programs did not cover fertility services, and among those who had limited coverage, no state provided comprehensive IVF services to Medicaid enrollees.
What are the chances for greater expansion of assistance with IVF costs and coverage?
IVF moved to the policy spotlight right after a 2024 ruling of the Alabama Supreme Court categorized embryos created through IVF as “unborn children”, bringing media attention to the potential implications of fetal personhood laws, which give rights to embryos. Fetal personhood is embedded in some state abortion bans and a variety of other public policies. The language is also widely promoted in conservative circles. For example, the Project 2025 blueprint refers to embryos as “aborted children” and opposes research using embryonic stem cells (which can be obtained through the IVF process). Many influential conservative groups, including the Southern Baptist Convention and Catholic Church, expressly oppose IVF.
This announcement comes at a time when the Trump Administration has laid off the staff of the Centers for Disease Control Division of Reproductive Health, including those who worked on the Assisted Reproductive Technology Surveillance team that ran the National Assisted Reproductive Technology (ART) Surveillance System, which collected data from assisted reproductive technology clinics in the U.S. and calculated and reported success rates for each clinic to monitor clinic outcomes. More recently, the majority of staff at the Office of Population Affairs under which the administration had proposed starting an Infertility Training Center was also let go. It is not clear what staff are left at HHS or CDC to track the provision of infertility treatment and to regulate the services.
To assist all people with coverage who want or need fertility care as the President promised during his campaign, Congress would need to approve a new law to either require or subsidize fertility and IVF coverage. In 2024, Congressional bills that would have established a national right to IVF failed as a result of opposition from nearly all Republican Senators. In May 2025, Representative Lauren Underwood introduced the Health Coverage for IVF Act of 2025, which would require small and non-group plans to offer comprehensive fertility coverage including IVF, but there has been no congressional movement on this bill to date.
