Dalhousie health plan ‘insulting,’ says student with ADHD
Student forced to pay out of pocket for her prescribed medication
December 1, 2021, 1:58 pm ASTLast Updated: December 1, 2021, 1:58 pm
Dalhousie student Pascale Legault will have to pay over $1,000 towards medication for her ADHD, even though she has insurance coverage provided by the school’s student union.
Legault says she was diagnosed with attention deficit hyperactive disorder this summer. It’s a condition that can hinder academic performance if not treated.
Her student health insurance plan paid for none of the assessment, even though they advertise 100 per cent coverage for psychologists, social workers and psychotherapists.
“The policy covers 100 per cent up to $1,000 … there’s like fine prints at the bottom that say except for psycho-educational analyses,” Legault said.
But Legault’s frustration with insurance payments was just beginning. When it came time to pay for the medication she was prescribed, she was met with an even larger financial burden.
Though most drugs covered by the plan get $5,000 worth of coverage over a single academic year, the drug Legault needs, known as Vyvanse, is only covered for one-tenth of that.
“It’s a stimulant. So those are capped at $500 a year,” she said.
Dr. Glenn Andrea, who practises at Dalhousie Student Health & Wellness Centre, said the drug is important medicine for ADHD patients.
“The medication for attention deficit disorder allows most patients to focus longer, to stay on task without distraction and to initiate tasks,” said Andrea.
“Most patients who also have anxiety in addition to ADHD also note reduction in their anxiety while on medication,” he said.
Legault said the drug “absolutely changed my life so far just beyond academics.”
But because of the coverage cap on her medication, Legault will have to pay over $1,000 out of pocket during the academic year.
Students pay for the university health insurance plan via their tuition. For this academic year, Legault was charged $468.64 for the plan. Students can opt out if they have their own insurance.
Potential for misuse
The reason for the difference in coverage is fear that prescriptions will be abused as Vyvanse is a controlled substance monitored at both the provincial and federal level.
StudentVIP, which brokers the health plan, said the cap is a measure to prevent misuse of medications. But they also said they can ask a doctor to consent to remove the cap.
“Student VIP utilizes a … stimulant cap to prevent misuse of medications. We request a physician’s consent to lift … stimulant caps to ensure that those students who cannot live without these medications are covered up to their overall drug or extended health plan maximums,” Alec Smith, a spokesperson for the organization, said in an email.
“It’s frustrating because I just got told that I’m going to use these pills for the rest of my life. And then insulting because the reaction is – we’re gonna treat you like a drug dealer,” Legault said.
Legault described her reaction to StudentVIP’s policy of requesting a lifting the cap as “pissing her off.”
“Nowhere in my plan documents, on their website, or on their app does it say that that is even remotely a possibility,” she said.
“How many other students are paying exorbitant out-of-pocket costs for medications they need, when the insurance company will cover them, they just won’t tell you that they’ll cover them?” she said.
She plans to ask her doctor to lift the cap, “because I’m broke and can’t imagine going back to life without these meds.”
Legault is also not swayed by the argument that the misuse of medications is just cause for the much lower default coverage.
“Many university kids end up selling their their Adderall prescriptions. That’s not my fault,” she said.
The Dalhousie Student Union said that they are reviewing their coverage with StudentVIP and the cap on Vyvanse is one of their anticipated changes.
“We hope that some of the revisions we make to the plan this year will remove the requirement for students to seek appeals for coverage caps. StudentVIP has noted that changes to the plan may impact the premium cost to students,” the student union said in an email.
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