Yale Health Plan makes changes

Students under the full Yale Health Plan will have reduced medical costs starting August 1, 2011, Yale Health announced to students in an email Tuesday.

The result of recommendations given to the Provost’s Office by Yale Health’s Student Coverage Task Force, the cost reductions aim to address student concerns about medical coverage costs, Director of Yale Health Paul Genecin said. The changes implement a new payment system for prescription medications. Similar pharmacy benefits have already been in place for employees and faculty on the Yale Health Plan since last year.

“This is a way of sharing costs in pharmaceuticals to provide incentives for patients to use less expensive drugs to keep their costs down,” Genecin said. “The most important concern for the taskforce was prescription medication costs.”

Under the Yale Health Plan, students can choose between two options: subscription to both Hospitalization/Specialty Care and Prescription Plus coverages or just to the hospitalization option for emergency services and care beyond primary doctor visits. The supplementary prescription plan covers medication and additional inpatient psychiatry and substance abuse services.

Starting in August, the revised plan will replace the current medication payment system with a new partial payment structure for purchases made at the Yale Pharmacy for students subscribing to the Prescription Plus coverage.

For students subscribing to the Prescription Plus coverage, the revised plan replaces the current medication payment system with a new partial payment structure for purchases made at the Yale Pharmacy.

Currently, students are fully responsible for prescription medication costs until these costs exceed $100 ­— the annual deductible — after which the Yale Health Plan will pay 80 percent of future prescription costs up to $15,000 each year. With the implementation of the revised plan, though, this arrangement will be replaced by a co-pay structure that divides medication into three separate tiers with monthly flat fee rates: generic drugs at $10, preferred brand-name drug at $25, and non-preferred drug at $40.

However, in order to off-set the cost of this richer drug coverage and reflect the higher cost of care outside Yale Health, a new co-pay will be implemented in the hospitalization and speciality coverage, Genecin said. Instead of receiving full coverage of visits to referred specialists outside the Yale Health Center, all students subscribing to this coverage will now have to co-pay a flat fee of $10 per visit.

“The task force has largely focused on prescription coverage in the last two years and trying to figure out how to improve the plan without resulting in large cost increase,” she said. ”The old plan was an archaic model that was disliked by many students and didn’t meet the needs of some with chronic conditions. The new plan is more similar to the programs at our peer institutions and a real improvement for students with Prescription Plus.”

The changes to the Yale Health Plan do not affect students not enrolled in the plan, though every Yale student receives basic coverage free of charge.

Correction: April 14, 2011

An earlier version of this article incorrectly stated that students currently under the Hospitalization/Specialty coverage are responsible for the complete cost of visits to referred specialists. Instead, these visits are now fully paid by Yale Health and students will start paying $10/visit with the new plan.

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