Changing Regulations, Rising Costs Require Smarter Insight on Student Health Plans

By Kristen Devine

Changing Regulations, Rising Costs Require Smarter Insight on Student Health Plans

Regulatory uncertainties of the Affordable Care Act, loosening of regulations by the federal government and the subsequent exemptions being allowed, compounded by the rising costs of prescription drugs, mean colleges and universities face tougher and tougher decisions in weighing the health and well-being of their students against their bottom lines.

College and universities that offer student health insurance (SHI) provide an invaluable service to their student populations. Younger undergrads might not retain coverage under their parents’ family health plans if they go to college in another state, out of their coverage region. Older students, whether returning to college later in life or working on graduate degrees, who need and demand lower cost options might not be able to find an affordable solution on their own. International students need access to a plan that will protect them in the U.S. and provide them with easy access to care.

Unlike most employer health plans, SHI offers low or no deductibles, low co-pays, and easy access to providers through PPOs, as well as voluntary coverage options for dental, vision, personal property and worldwide travel. SHI is also designed to integrate with campus health care centers so that students can be assured affordable treatment on campus, without tracking down a provider in their network or leaving campus whenever they get sick or injured.

In the face of today’s uncertainties and pressures, a regular analysis of health claims can be an eye-opening way for a college to understand what areas need more attention or investment and thereby make informed decisions regarding their health plan.

Consider the issue of prescription drugs. Rising drug prices are a problem across every sector of the health insurance market. In fact, prescription drug spending is rising faster than any other part of overall health care costs. With mental health issues on the rise across colleges and universities, administrators are facing a double whammy when it comes to deciding what level of benefits their health plans should include.

On one campus, for example, we did an analysis and found an increase in prescription drugs for mental health. This discovery led to a closer look at which series of drugs should be prescribed.

We found that our options were limited to a generic form of the antidepressant Wellbutrin that requires three pills per day compared to just one pill per day with Wellbutrin. Medically, the results for both prescriptions were the same. However, in a student population, it was clear that students taking one pill a day were more likely to remain on the treatment cycle than students who had to remember to take three pills a day.

Perhaps unsurprisingly, the one-pill-a-day prescription was significantly more expensive than the three-a-day counterpart. Now the issue became one of weighing efficacy against cost: by including the prescription in the formulary what is the potential cost to the insured student population?

Managing prescription drug abuse, such as recreationally used ADD and ADHD drugs, is another issue colleges must weigh. Controls to curb abuse are available but add expense. For example, the drug Vyvanse offers a unique time-release and is less likely to be snorted for recreational use. College health providers prefer this drug, but it is often excluded from the formulary and requires prior authorization due to cost. Understanding the pharmacy management program that is part of the health plan is something that every college health administrator will find useful.

Ultimately, the goal is to keep college students in school and on track to graduate. By offering SHI, colleges and universities add tremendous value, especially when health insurance is mandated. Working with an experienced broker who monitors the market and can help find personalized plans to meet the needs of each institution is the only way to navigate the complexities of these plans. For more information, contact