Progyny (NASDAQ:PGNY) CEO Pete Anevski outlined how the company is thinking about utilization trends, forecasting, and the rollout of its new fully insured product during a fireside chat hosted by KeyBanc healthcare tech analyst Scott Schoenhaus. The discussion followed the company’s fourth-quarter earnings report and came as Progyny заверш up its selling season and began launching a new cohort of clients.
Eligible lives update and why Progyny focuses on utilization
Schoenhaus asked about a reported decline of roughly 400,000 eligible lives compared with about 90 days earlier, which he characterized as tied to administrative finalizations or corrections from certain employer clients. Anevski said the change reflected the way different clients report eligibility counts at varying frequencies, generally at least quarterly.
How new client cohorts translate into revenue timing
The conversation also addressed how utilization from a new cohort flows through to higher-revenue fertility treatments over time. Anevski framed the dynamic in the context of quarterly reporting cutoffs, saying the smallest portion of people both begin with an initial consultation and start treatment within the first quarter. He described Q1 as having the highest proportion of people beginning their fertility journey, but said most treatment activity tends to show up in subsequent quarters.
According to Anevski, utilization from Q1 consults typically becomes more meaningful in Q2 through Q4. He explained that members may start a retrieval cycle in Q2 and complete a transfer in Q3 or Q4 depending on personal timing. He added that some individuals may complete more than one retrieval before a transfer, and said the average is roughly 1.8 retrievals per live birth, while cautioning not to hold him to the exact figure.
Forecasting methodology: client history, industry data, and journey signals
Asked what inputs inform Progyny’s revenue and utilization expectations early in the year, Anevski said the company relies on years of data across existing clients and industry-level patterns for new clients. He said Progyny’s forecasting approach considers client industry and how those employers are performing relative to their industries, along with what Progyny typically sees from first-year client behavior in those categories.
He also said the company’s algorithm accounts for where individuals are in the fertility journey, including:
- How much of the population is doing an initial consult versus beginning treatment
- Whether cycles are elongated based on the timing of scheduled appointments (including into later quarters)
- Seasonality and timing considerations, such as holidays and personal scheduling factors
Anevski said the methodology has generally been a good predictor over time, while acknowledging 2024 as a “unique” year in which Progyny saw a utilization dip in the middle of the year that began to recover by year-end. He said the company’s “best guesses” were that the political environment influenced that pattern. He added that the company continues to refine forecasting as it accumulates more cohort data each year.
Progyny Select: go-to-market plan, underwriting, and risk guardrails
A significant portion of the discussion focused on Progyny Select, the company’s fully insured offering aimed at small group employers. Anevski described the go-to-market strategy as being routed through the same distribution channels small groups already use to purchase premium-funded medical plans—brokers and consultants tied to general agencies, professional employer organizations (PEOs), and payer relationships.
He said the near-term effort is focused on signing up distributors and training brokers so they are prepared for the most important sales window: fourth-quarter renewal season for small group plans, which are typically renewed annually. While the product is being launched now from a commercialization standpoint, Schoenhaus noted—and Anevski agreed—that the company expects to go live with the product in 2027, when it would begin to reap revenue.
On costs, Anevski said the model is largely commission-based, with commissions paid as revenue comes in. He added there is some upfront investment tied to the company’s sales force and support staff working with distributors and training, and said that spending is already embedded in guidance. He said there is no variable expense expected this year tied to the product.
On underwriting and risk, Anevski said Progyny has years of data, including experience with smaller clients, that it will use to underwrite the product. He also outlined design features intended to manage utilization risk, including:
- Targeting small group employers rather than the larger ASO population Progyny serves today
- Covering IVF only and excluding elective egg freezing, which he said improves predictability
- Including utilization management guardrails and lifetime dollar maximums for high-cost claimants
Anevski argued that once the fully insured risk pool grows to “hundreds of thousands of lives,” it should behave more like Progyny’s broader book of business, though he acknowledged early performance may fluctuate while the pool is smaller. He also highlighted annual repricing dynamics, saying premiums can be adjusted each year based on experience, similar to broader medical plans.
Asked whether the fully insured business could become margin accretive over time, Anevski said the potential exists, but stressed the company would price with an eye toward what the market will bear while keeping the incremental premium relatively small as a share of an employer’s overall medical and pharmacy spend. He also pointed to fertility benefits as particularly relevant for employees in the “30-42-year-old range,” describing them as an important segment of the workforce.
TrumpRx, AI investments, and competition
Schoenhaus asked about “TrumpRx” and whether employers might shift toward cash pay or subsidies for employees. Anevski said the fertility drugs included under TrumpRx do not cover all medications required for a fertility cycle. He also characterized TrumpRx as an extension of patient assistance programs that are not available to individuals who have coverage, including reimbursement, noting that invoices can state the benefit is not available if someone is reimbursed. He said patient assistance programs have existed for a long time and that the TrumpRx announcement primarily “shined a light” on them, adding that Progyny does not expect an impact and has not seen one so far.
On technology, Anevski said Progyny is making AI, data, and technology investments intended to augment services across stakeholders—internal teams, providers, employer clients, and patients. He cited opportunities to reduce “homework” and friction for patients on a fertility journey, automate manual tasks, and provide “next best action” recommendations informed by data. He also said technology can support provider partnerships and potentially reduce costs for providers, which could strengthen Progyny’s negotiating position over time.
Finally, discussing competition, Anevski said the most recent selling season did not feel more competitive than prior seasons. He said Progyny continues to win “the majority of the time” against competitors collectively. He also noted that some competitors have faced challenges, including one small competitor that went bankrupt during the prior year, and said funding and cash burn pressures among competitors have created “noise.” Overall, he said Progyny feels competition is no worse—and in some areas “a little bit less”—and that the company continues to invest in its offering to widen its moat.
About Progyny (NASDAQ:PGNY)
Progyny, Inc is a New York-based fertility benefits management company that partners with employers and health plans to design and administer comprehensive family-building programs. The company’s digital health platform integrates clinical expertise, patient support tools and data analytics to help members navigate fertility treatments, from in vitro fertilization (IVF) and egg freezing to surrogacy and adoption. By focusing on outcomes-based care, Progyny aims to improve success rates while controlling costs for its clients.
The core of Progyny’s offering is its proprietary Smart Cycle® benefit, which bundles clinical, emotional and logistical support into a single package.
