Student union sets $50,000 cap on prescription coverage

by Leo Almazora06 Sep 2018

The student union of Concordia University in Quebec has approved a cap of $50,000 on prescription-drug coverage for all students under its health plan.

According to The Concordian, the Concordia Student Union (CSU) voted on August 22 to introduce the cap upon the recommendation of its health insurance provider, Alliance pour la santé étudiante au Québec (ASEQ). The insurer said the CSU was the last student union in Quebec that hadn’t approved such a limit.

“We are not aware of any students who have made claims to this level,” ASEQ said in a letter to the union. “While the risk is abstract, it is not zero, and an overall limit is therefore recommended as a precautionary measure.”

ASEQ said that it reassessed the risk for the CSU in light of recent developments in pharmaceuticals, particularly those concerning new specialty medications, including biological medications, which can be extremely expensive.

Under the previous regulations, a single abnormally costly prescription-drug claim would have led to increased fees for every student. Increases could have reached anywhere from 5% for a claim exceeding $25,000 to 35% for a claim over $300,000. With the new rules, students would have to cover any costs over $50,000 for all prescription drugs covered by the university health plan.

“This policy will not mean that people will be denied healthcare,” said CSU Finance Coordinator John Hutton. “It means that when the insurance plan the student has is insufficient to cover [their condition], it will give them opportunities to activate what’s called a compassionate care clause that a lot of pharmaceutical companies are required to have.”

Hutton added that the $50,000 limit far surpasses any claim likely to be made by a student. Documentation from the CSU showed that since 2012, the largest claim made by a single student amounted to $33,572.89 for the 2013-14 academic year, followed by $16,810.99 in 2014-15.