Fig. 1

The multi-level active implementation zone for the fertility preservation benefit mandate. The implementation zone includes the state insurance regulator, insurers, and clinics. Downstream of the Big P fertility preservation benefits mandate policy, and both Big P and little p policies arise in regulator, insurer, and clinic implementation to enable patient access to these insurance benefits. Through multi-level implementation, these downstream policies reshape and dilute the policy package. P Big P, p little p, E exploration, P preparation, I implementation, S sustainment, O outer context, In inner context, B bridging