To examine the temporal relationship between the anti-discrimination rules of the Affordable Care Act, which took full effect in 2017, and the incidence of commercial claims for gender-affirming care, as well as cost sharing for these services.
Methods:
We used a previously described algorithm to define a cohort of gender-diverse adults in the MarketScan Commercial Claims and Encounters Database. Claims for gender-affirming medical and surgical care were identified using International Classification of Diseases and Current Procedural Terminology codes plus pharmacy data; the annual incidence of surgical claims was calculated. Interrupted time series analyses were used to evaluate the temporal relationship between claims and anti-discrimination legislation. Claims data were also used to evaluate the patient contribution towards services.
Results:
There were 70,733 gender-diverse adults included in the study and 36,702 (51.9%) of them filed claims for gender-affirming care. The incidence of persons with claims for gender-affirming surgery increased from 0.002% in 2009 to 0.012% in 2021. Interrupted time series analyses demonstrated a greater year-to-year increase in claims after anti-discrimination policy influences took effect. This change was greatest for transmasculine chest procedures. The median lifetime net payment for gender-affirming surgery was $12,429.10 and cost sharing was $1019.20 (8.6%).
Conclusion:
Commercial claims for gender-affirming surgery increased temporally with respect to implementation of anti-discrimination legislation and cost-sharing was reasonably low. However, many gender-diverse persons did not have claims for gender-affirming care, which may indicate continued out-of-pocket payment for these services.
Eric Walton,1 Pranay Manda,2 Dattatraya Patil,2 Akanksha Mehta2
- Department of Urology, Emory University School of Medicine, Atlanta, GA.
- Department of Urology, Emory University School of Medicine, Atlanta, GA.
Walton E, Manda P, Patil D, Mehta A. Impact of Anti-Discrimination Legislation on Access to Gender-affirming Care: A Commercial Claims Analysis. Urology. 2024 Jun 2:S0090-4295(24)00419-9. doi: 10.1016/j.urology.2024.05.025. Epub ahead of print. PMID: 38834147.