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.