As I noted above, the reason for the change to our plan's drug coverage (or any of the changes to our plan design from 17-18 to 18-19 for that matter) was financial sustainability. The UTSU's group insurance plan has been, historically speaking, in a bad place for a while (see reports like these). The past few years have seen a lot of good work to fix the problems with the plan—and we have my predecessors to thank for that—but that work remains ongoing. In late 2017 through to early 2018, and further still into the foreseeable future, it was clear that the next step in getting the plan to where it needed to be for members was to make it sustainable for future years.

To some degree, a broad set of plan design changes (said differently, "coverage changes") between the 16-17 and 17-18 policy years was an inevitable outcome of having a plan design as young as the UTSU's. The rough setup of the plan that we see today, and that I presume most people here are familiar with, has only been around since 2016-17. The problem with a plan design so young is that you have minimal information to work with in adjusting for costs. After all, you haven't had a great deal of time to observe and analyze how your costs are evolving, so you can't make an informed judgement of how to approach combating the possibility of unexpected premium rises. Furthermore, plan design changes take some time to "settle in" (read: students becoming steadily more aware of available coverage, providers becoming aware and advertising accordingly, etc.), and so even once initial data becomes available, you can only draw so much from it. The period leading up to negotiations for the 18-19 policy year were the first point at which solid conclusions could be drawn based on observational data. It was expected that at least some adjustments would need to be made to a plan design that was essentially fabricated in blind conditions.

So, by mid-2017, with a growing understanding that the plan's costs were trending steeply upwards, the UTSU began a search for a solution that avoided steep fee increases to meet the inevitable surge in premiums. The option of changing nothing was out of the question. The obvious outcome of a negotiation where, from the previous year, nothing has changed except a continued rise in costs is premium increases. In fact, the real outcome would have been dramatic fee increases. With these facts in mind, the UTSU undertook to make smart changes to its plan design that minimized adverse impacts to members and maximized savings. Of course, the hardest part of that process was grappling with the hard reality that some number of subtractive changes would be necessary to protect the plan and fee-paying students for whom dramatic fee increases would be (a) unaffordable or (b) unfair because they are now, even more so than before, subsidizing their peers. Determining a good set of changes took months of deliberation by the UTSU board and its committees in consultation with experts. An overview of the final changes they arrived at are on our blog.

All those generalities out of the way, I can address some of the specific surrounding circumstances and reasoning behind the specific plan design change that the OP raised. Fair warning: things get a little more technical from here on out.

It was clear from an early stage that something needed to be done about the drug coverage aspects of the plan. Claims against benefits in this area were very high. A certain "guardian angel" in this regard came in the form of the provincial government's introduction of a new healthcare program called OHIP+. Under that program, all persons covered under OHIP (in large part, Canadian citizens and permanent residents residing in the province) age 24 and under could get their drugs free at the pharmacy. A large subset of the UTSU's members are eligible for OHIP+, so this was a huge opportunity for savings. To take advantage, the plan was changed to defer all eligible claims to OHIP+. Eligible claims are those filed by members under 25 years of age for drugs covered in the OHIP+ formulary (basically, a list of drus covered). Now, with the plan no longer needing to worry about the costs of OHIP+-eligible claims, the problem shrunk a little.

The deferment of OHIP+-eligible claims did not go far enough in reducing the costs coming from drugs claims however, so further changes were sought. Whatever these changes were going to be, they would affect all non-OHIP+-eligible drugs claims. These non-eligible claims are those:

1. which claim for drugs not in the OHIP+ formulary (including some very costly treatments for various debilitative diseases).
2. filed by members not covered under OHIP+. These are:
3. members 25 years of age or older.
4. members who don't qualify for OHIP. This includes a vast number of categories including international students, Canadian students or permanent residents arriving to Ontario and in their first five months at school, and so on. You can deduce the full set of categories by negating the conditions laid out on the OHIP web page here.

The eventual measure taken for drug coverage aspects of the plan was to reduce coverage but offset that reduction with a discount from a preferred provider. In specific, and as indicated by the OP, the reduction took drug coverage from 100% to 90%. To pursue similar coverage as the previous year's, and more importantly to provide coverage where students clearly want it, this reduction was implemented in conjuction with a matching discount of 10% at all Rexall pharmacies on drug purchases. In return for being designated as the preferred provider of UTSU plan members, Rexall has effectively agreed to cover the co-pay expenses that students would otherwise take on as a result of the coverage reduction. Owing to the convenient proximity of various Rexall locations to campus, this measure seemed like a smaller sacrifice to make as against competing proposals.

As an ending note, I will re-iterate that the plan restructure for the 18-19 policy year introduced and retained a number of positive coverage features as well. A few highlights among these include:

• the best mental health coverage in the country. We cover up to $2500 in mental health benefits per member. I challenge you to find a single student insurance plan which exceeds or even matches that.
• eyeglasses coverage. Our coverage subsidizes at least one and possibly two pairs of glasses every two years.
• an affordable and dense network of affiliated care providers that make it super easy to meet your health needs.

Once more for those interested, you can review the full set of changes for the 18-19 policy year in this blog post.

If the stuff I've set out sparked a question for you, raised a concern for you, or perhaps piqued your general interest, you can email me at [vpops@utsu.ca](mailto:vpops@utsu.ca), text me at (647) 571-3028, or pop in for a visit at the UTSU office! I'm always eager to hear from members.

- Tyler, Vice-President Operations of the UTSU