Yarbrough: A failing health plan

For most Yalies, a visit to the pharmacy often means a long wait in the cramped entryway of the University Health Services building. For me and other HIV-positive Yalies, however, it’s usually much worse.

We have to trudge down to the Walgreens on York Street to wait in even longer lines, often only to hear that our prescriptions cannot yet be filled because of problems with our insurance. This ritual inconvenience then triggers a complicated morass of communications with a host of bureaucrats from York Street to Hillhouse Avenue to Hartford, sometimes even to Walgreens headquarters in Chicago. As I write this, I’ve just — finally — received a refill I ordered over a month ago.

Why the endless hassle? Because the Yale Health Plan’s Prescription PLUS plan covers only 80 percent of our prescription drug costs. The remaining 20 percent amounts to about $500 every month for most HIV-positive patients. Living on a graduate student stipend of about $2,000 per month, I’m forced to rely on a targeted state welfare program to make up the difference.

This publicly funded program cannot distribute funds through private-membership pharmacies such as the one at YUHS. And so I trudge to Walgreens, where most pharmacy employees believe the store never accepts Yale insurance under any circumstances. It falls mostly to me to inform them that I fall in an unusual but crucial exception to that policy — and to walk them through the steps they have to take in their own computer system to execute this unusual billing arrangement.

And get this: I’m actually lucky because my chronic illness happens to be HIV.

Students and staff with other expensive-to-treat chronic illnesses often are not eligible for state assistance such as the programs targeted at HIV. While Prescription PLUS leaves me with a burden measured in hours, arguments and occasionally (and dangerously) missed doses, the burden borne by other chronically ill Yalies is also measured in dollars.

For all of us, this adds up to a massive distraction from our teaching and research work. It lengthens our time here and disrupts our focus, even beyond what would be medically required by the chronic condition alone. Simply put, Prescription PLUS in its current form doesn’t just fail to foster Yale’s core mission when it comes to the chronically ill. It actually impedes it.

Nor does Prescription PLUS serve healthier students very well. Between its roughly $750 annual premium and $100 deductible, Prescription PLUS enrollees won’t break even unless the full retail value of their annual pharmaceutical costs approaches $1,100. Few routine drugs cost that much. Even after the recent increase in birth control costs, for example, it still makes more financial sense for most sexually active Yale women not to enroll in Prescription PLUS.

With fewer enrollees at the healthy end of the scale, the greater financial burden of the chronically ill must be borne largely by them and the University alone, assisted only by those students who are excessively cautious or who forget to opt out each term.

A revamped prescription drug plan could better serve both chronically ill and healthier students. There are several options the administration might consider. The premium could be reduced or, for Ph.D. students, eliminated. Alternatively, the administration might reduce the copay costs to a lower percentage rate or — as other universities do — move from a percentage to a flat-rate system, charging a fixed copay for a month’s worth of prescriptions.

Each of these options would result in a plan that makes more financial sense for healthier students, resulting in greater enrollment. Plus such changes would sharply reduce the extraordinary financial burden currently borne by chronically ill students. Moreover, the expense of insuring chronically ill students would be distributed across a wider population than is currently the case. And each of these options would mitigate Yale’s current policy of outsourcing 20 percent of the cost of treating its HIV-positive students to under-resourced state governments. This is not a small consideration in these times of tight public finances and of popular anxiety that rich universities are unduly hoarding their endowments.

Each option presents its own strengths and weaknesses, each of which should be debated in more detail. But any of these would improve upon the current Prescription PLUS plan, which serves almost no one very well.

Michael Yarbrough is a fourth-year graduate student in the Sociology Department.

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