CAN ORAL contraceptives be included as part of the prescription benefits of the QualChoice health insurance plans available for student purchase? Absolutely yes. Are there pros and cons to including this benefit? Again, the answer is yes. And the student members of the Student Health Insurance Committee have the prevailing influence on this decision.
Five years ago, Trigon provided health insurance plans to students who needed to buy their own coverage in order to be compliant with U.Va.'s regulation that all students maintain health insurance while enrolled. Student Health provides primary care professional services, education and outreach for free, but so-called third party coverage protects students from financial risk if diagnostic, specialty or inpatient services are required.
That was then. Since I came to Student Health in 1993, I've witnessed the effect that students have on shaping their insurance plans. It was in 1993 that a group of Law School students surveyed their peer institutions to assess the adequacy of the insurance plans offered at that time. The results of the survey were confirmed by the broader student membership of SHIC and led to the development of new plans designed to meet students' needs. The new provider was QualChoice, the company with a relatively brief but successful track record as the health insurer for all University employees and their dependents.
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Those student plans addressed student concerns, specifically no maximum dollar limit for coverage, optional dental benefits and prescription benefits. Five years ago, no prescription drugs were covered, and it's only in the last few years that employers such as U.Va. have added oral contraceptives to their employees' benefits.
The Law School's Contraceptive Coverage Committee has raised awareness of and generated support for adding oral contraceptive coverage to the QualChoice student plans, and this issue was publicly addressed on Feb. 6 at a forum held at the Law School. As a member of the panel for that event, I heard the arguments first hand, and I'd like to respond with two purposes in mind. The first is to explain why, today, the student QualChoice plans don't include oral contraceptive coverage (except for medical reasons). The second is to describe the decision-making process and to promote the most effective interaction and outcome of the SHIC meeting planned for Feb. 27, at 4:30 in Minor Hall auditorium.
When SHIC met in April 2000, the inclusion of oral contraceptives in the prescription benefit was discussed. The decision was to continue excluding oral contraceptives from coverage, mainly due to cost. Adding the benefit would increase the premium, and birth control pills are available at the Student Health pharmacy for $16 per month. This amount is less than the $18-$20 co-payment for the medication, and the patient pays the $16 price. It can and has been argued that not all oral contraceptives are purchased at the Student Health pharmacy. Our hours are limited, students go out of town for breaks and summer, and the advantage of using the mail order benefit (three month's supply costs two month's co-payment) is not available.
This year the issue will be addressed by SHIC members and the audience. Voting members of SHIC are appointed by Vice President for Student Affairs William Harmon and include students, Student Health clinicians and administrators, and faculty and administrative staff from the College and schools around Grounds. Because most of the enrollees in the plans are graduate and professional students, the majority of student representatives are from these areas. QualChoice representatives are active participants, and it is they who will present benefit options and premiums for SHIC's consideration. The discussion that follows is typically a give and take about how to best maintain benefits while controlling an increase in premiums.
Premiums are based primarily on the experience of this group of enrollees (or how much was paid out to cover claims over the recent history of the plan) and industry inflation (this year inflation in prescription medication alone is over 25 percent). If a benefit is added, the premium goes up unless some other benefit is reduced or more costs are paid by the enrollee (higher co-pay or co-insurance, so-called "out-of-pocket" costs).
I've heard the argument that the cost of QualChoice plans for University students should not increase because other comparable schools offer plans, including contraceptive coverage, at comparable or lower premiums. We're developing a comparison based on full descriptions of those plans, as it's impossible to judge on price alone. That information will be available by the SHIC meeting.
To reiterate, Student Health and QualChoice are in no way opposed to the inclusion of oral contraceptives in the prescription drug benefits associated with both student insurance plans. I look forward to a lively and thoughtful discussion of this and other insurance issues on Feb. 27.
(Allison Montgomery is the director for administration at the Department of Student Health.)
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