FairShot

The First IVF Medication Exchange

Summary

When I needed fertility treatment, my insurance carrier refused to cover any of it since I’m married to a woman, not a man. (I twice appealed the denial, but Oxford maintained that sexual orientation is not among the classes protected from healthcare discrimination in NY State.)

My wife and I then spent approximately $40,000 to conceive our son—a figure that would’ve climbed higher had we not saved $2800 by combing message boards and listservs for donations of excess IVF medication. While we were elated to have found the medication we needed, exactly when we needed it, we were mystified to learn that there was no app designed for this purpose or any like it.

Role

UX Writer & Researcher

Duration

6 weeks

Problem

IVF medication typically costs $3500-$5000 per cycle without insurance coverage. Insurance carriers often deny coverage for IVF medication, even if they fully or partially cover IVF procedures. Since dosages are adjusted throughout cycles based on individual response, some patients are left with an excess supply while others face a shortage.

There is no digital platform or physical space for exchange of IVF medications. Donors and recipients attempt to make these connections on social media, message boards and listservs, but these nonspecific means are inefficient, and such posts are often blocked by moderators.

Solution

With FairShot, the IVF community has a platform to do what we’ve done piecemeal for ages: save one another from wasting medication and money. In turn, we ease the burden of a financially, medically and emotionally grueling process. FairShot approaches IVF as a justice issue, aiming to equalize access to family-building regardless of whether patients have insurance coverage for IVF procedures or medication.

Goals

Learn what proportion of US IVF patients lack IVF medication coverage.

Gauge the extent to which prospective users would try an IVF medication exchange app.

Search any existing resources for IVF medication exchange; identify pain points.

Assess prospective users’ concerns about an IVF medication exchange app.

Establish personae of those who use current resources for IVF medication exchange.

Understand legal implications, including how they vary state to state & country to country.

Competitive Analysis

View full chart

Competitive analysis yielded only inexact points of comparison—there are no competitors whatsoever in the digital space. The closest competitors are technologically primitive drug repositories, most of which are limited to residents of the state in which they operate, and some of which carry income restrictions for those receiving donations. Only one such repository accepts IVF medication, although it seldom receives any; the only eligible recipients are uninsured/underinsured Iowa residents. There are some fledgling medication donation platforms across various countries, primarily for cancer and HIV medication. Further research is needed in order to determine their level of functionality and use.

conversation mining

View full chart

I searched message boards/forums such as Reddit, WhatToExpect, BabyCenter and The Bump. Conversation mining revealed the range of circumstances that lead users to donate or solicit IVF medications—many users were quite forthcoming about their personal stories. Posts offering medication or requesting it often led users to commiserate about the financial, emotional and physical hardships of IVF. Conversation mining clearly illuminated the use case for a platform like FairShot.

Survey

I administered surveys to volunteer participants culled from a highly active email listserv of local parents. Privacy policies as well as bureaucracy precluded the possibility of drawing participants from fertility clinics or pharmacies.

Survey findings:
• The proportion of users who have IVF coverage.
• The proportion of users who have IVF medication coverage.
• Users’ current pain points concerning IVF medication exchange.
• Which features users seek in an IVF medication exchange app.
• Users’ concerns about trying an IVF medication exchange app, from both donor and recipient perspectives.
• Users' dealbreakers (ex: “I wouldn’t use the app if I had to register with identifying information.”)

Coverage for IVF procedure & medication

If you had medical insurance while doing IVF, did it offer IVF coverage to any of its members?

Yes
Yes, but there were exclusions
No
I don't know
N/A - Didn't have insurance

Not including medication, what percentage of your IVF costs (tests, retrievals, transfers, bloodwork) were covered by insurance?

0-25%
25-50%
50-75%
75-100%

What percentage of your IVF medication costs were covered by insurance?

0-25%
25-50%
50-75%
75-100%

Past Sources of Medication / Donation Behavior

Survey participants reported obtaining IVF medication by the following means—whether for an egg retrieval, embryo transfer or associated treatment:

Purchased from pharmacy - 100%
Received donated from online message board - 23.7%
Purchased through online message board - 13%
Received donated from doctor’s office - 13%
Received donated from family/friends - 13%
Purchased from friends/family - 0%

Each cycle typically requires multiple medications, which accounts for the fact that these figures exceed 100%. While all patients purchased at least some medication from pharmacies, the second-most common source was donations from online message boards—suggesting that patients are already doing what FairShot would facilitate.

Gauging interest for a Platform like Fairshot

Donating leftover meds

If an IVF medication exchange app had existed during your treatment, how likely would you have been to DONATE leftover medication (if you’d had it)?

Results

78.9% of respondents indicated that they would be highly or somewhat likely to DONATE to an app like FairShot.

Highly likely
Somewhat likely
Unsure
Somewhat unlikely
Highly unlikely

Accepting donated meds

If an IVF medication exchange app had existed during your treatment, how likely would you have been to ACCEPT donated medication (if you’d needed it)? 

Results

While most respondents indicated that they would be highly or somewhat likely to ACCEPT donations (52.6%) from an app like FairShot, they are more comfortable with DONATING (78.9%). Further research is needed to understand this rationale.

Highly likely
Somewhat likely
Unsure
Somewhat unlikely
Highly unlikely

Mission Statement

FairShot is a centralized venue where IVF patients can exchange fertility medication—saving time, cutting costs, and preventing waste.

Product Voice

Trustworthy

Description
We require that our donors do their best to verify the authenticity and safe storage of donations. We require multiple images of packaging per medication donated. Before we release donor contact information, recipients must attest to having reviewed these images.

DO
Require uploads of packaging, including medication name and strength.

Require uploads of expiration date as printed on packaging.

Assure users that we’ll never sell or disclose their personal information.

DON'T
Come across as too activist; this could be mistaken for irreverence.

Overemphasize our trustworthiness; this could come across as self-consciousness or as making promises we can’t keep.

Compassionate

Description
Unlike the drug companies, we’re with you in the infertility battle. FairShot is our contribution to reducing the stress and cost of IVF.

DO
Demonstrate that we understand the stress and cost of IVF.

Allay users’ concerns about medication exchange.

Have a thorough FAQ section, including material about the relative legality of using our platform.

DON'T
Pat ourselves on the back for our compassion.

Let compassion overshadow the mission or mechanics of the app.

convenient

Description
We aim to make IVF easier via our centralized space for medication exchange. No more digging through message boards not focused on this mission!

DO
Let convenience be modeled by the UX.

Include convenience as part of the mission statement.

DON'T
Tell users we’re convenient; let them discover it.

Use Onboarding and FAQ to break down steps for donating/receiving. This could reassure users who hesitate to create an account before first learning of the extent to which the app is actually convenient.

Sign-up Flow

The copy is straightforward since new users might have reservations that could be eased with matter-of-fact delivery. Creating a profile is optional—some users will prefer not to share any information about themselves and might abandon the app if this were mandatory.

Onboarding flow

There’s a significant amount to digest in the onboarding flow in order to dispel faulty assumptions and set users’ expectations. FairShot has no direct competitors and the concept of medication exchange is not widely known, so the “How It Works” screen is important in laying the groundwork. “Our Promises” sets an activist tone, leading new users to feel vindicated in their IVF experiences.

Listings Page

In order to facilitate ease of scrolling, the Forum screen displays only 1 image and 4 lines of basic information for each donation offered. Clicking on the preview leads users to additional images and further description on the next screen.

For clarity and organization, Offers and Requests are separated by tabbed navigation. Users can toggle between the two within a given search, or can stick to the tab that pertains to them.

Account Page

The Account page centralizes several aspects of user activity on one screen, which will be most useful if a user is requesting and/or donating multiple medications. The more actions a user has recently taken in the app, the harder it can be to remember and coordinate next steps. With that in mind, a centralized dashboard enables users to browse their Favorites, thank a recent donor, and edit the information about a medication they’re offering--all originating from the same initial screen.

Creating a post

A terms agreement immediately precedes the "Create a Post" screen; were the agreement presented only at onboarding, users would forget its content by the time they were ready to create a post.

In order to promote efficiency, each post requires that a dosage and quantity be entered. Without this information, donors and recipients would need to chat in order to determine whether they might be a match.

Donors must specify whether the medication has been opened, and recipients must specify whether they’d accept opened medication. If a chat were required for this, it might prove too much time or friction for donors.

Reflection

Fertility treatment is difficult for everyone; for me, the sting of insurance discrimination and resulting costs made the journey even more stressful. I first undertook the FairShot project out of anger, resolving to get pregnant "in spite of Oxford." When Competitor Analysis found no true competitors and Conversation Mining yielded staggering evidence of demand for IVF medication exchange, some of my anger morphed into excitement. The platform could be a balm to untold numbers of fellow patients, with value both intangible (community support) and concrete (substantial savings).

Next Steps

If I were to develop FairShot as an actual product, I'd administer surveys to a broader geographical range of IVF patients. Additionally, I'd conduct user interviews to gain a deeper understanding of patients' IVF medication needs and their concerns about FairShot. From there, I'd create personae of prospective users to represent the breadth of my target audience, their current pain points, and precisely what brings them to the platform.

Legal research is the most daunting consideration requiring further study. Message board moderators often delete posts that offer or solicit IVF medication donations, and it stands to reason that FairShot might be similarly reported. Drug companies are unlikely to take well to any loss of profit. I'd be eager to uncover whether there are legal loopholes that could protect FairShot's operations, such as the fact that goods, once purchased, are no longer the manufacturer's property.