Occasionally as we prepare for bargaining we uncover an issue that we didn’t know we had and that causes us to enunciate a principle. One such issue is the protection of our benefits coverage.
Our extended health benefits, like those of many other Canadian faculty associations, are broadly defined in the Collective Agreement, with much of the detailed coverage described in the health plan booklet. The Faculty Association was of the view that the University was not entitled to claw back benefits, nor had previously done so.
That all changed on May 6, 2018. On that date, UBC announced in a benefits newsletter that they had unilaterally reduced our coverage for medications. Given that there is already a per-member lifetime maximum for claims, and given that UBC is a large and financially stable institution, it is not clear why UBC felt that it was appropriate to reduce our benefits, but they did.
This event made us realize that we need to do three things: (1) prevent UBC from unilaterally reducing our benefits; (2) reverse the reduction in benefits that occurred on May 6, 2018; and (3) be vigilant to protect members’ health data and privacy.
- The most important issue is certainly preventing UBC from unilaterally reducing our benefits. Our benefits package is an important part of total compensation for which we have, in the past, traded off higher salary, and obviously, we don’t agree that the employer can reduce our total compensation unilaterally.
- A second issue is the specific reduction that just occurred, which we propose to reverse. UBC has now subcontracted, through Sun Life, with a company in Ontario called Cubic Health, to implement a program called FACET. According to Cubic’s website, FACET can help employers “save big with a new standard for prior authorization.” (Cubic Health). Under FACET, if your physician prescribes a drug that will cost over $5,000/year to treat a long list of health conditions like cancer, multiple sclerosis, or rheumatoid arthritis, you will need to get prior authorization (PA) from Cubic before the UBC benefits plan will cover your medications. These drugs, called PA drugs (and there are over 300 of them) may be approved for coverage, but that is now at the discretion of Cubic rather than a guarantee under our drug plan. Cubic advertises that in 40% of cases, they intervene with patients, meaning they will not cover exactly what your physician prescribed. For example, Cubic might refuse your claim unless your doctor prescribes another drug that is lower in cost. (This is not replacing the prescribed drug with a generic brand of the same drug, which pharmacists do routinely. This could include refusing to cover your costs until you have first tried a different drug from the one you were prescribed).
According to Cubic, this decision “cannot be appealed unless there has been a material change in your underlying medical condition that warrants reconsideration.” We think this means that Cubic asserts the right to deny coverage for the drug your doctor prescribed unless your condition worsens—in other words, unless you get sicker as a result—and even then it’s still their choice whether or not to cover your drug costs. It is of course not uncommon for a physician to prescribe a drug and, finding it not effective, or finding the side effects too severe, prescribe a different drug instead. But the physician is trying to treat your health problem, whereas Cubic has been retained to save your employer money. These are very different objectives. Furthermore, your physician is responsible and accountable for your care, whereas on Cubic’s forms you are required to agree to Cubic’s disclaimer of “all liability for any loss or damage suffered by any person, including (without limitation) me, as a result of the processing or outcome” of your request for coverage.
- The Cubic case highlighted for us another extremely alarming issue. When your physician prescribes a PA drug, Cubic will require you to sign a consent form. Here’s an example of one they had been using up until last week when the forms were changed after we expressed our concerns:
As of the date hereof, I hereby authorize any person or organization who has personal health information about me, including any health care professional (which includes but is not limited to physicians, medical specialists, physiotherapists, pharmacists or any other person who has examined or treated me), health care institution, pharmacy and other medical-related facility, and any authorized agent of mine to release and disclose to Cubic Health Inc. (“Cubic”) any personal information regarding my past medical history and current medical condition, including any relevant clinical notes (collectively, the “Personal Information”), which may be required to adjudicate the Request for Prior Authorization to which this Consent forms a part (the “Request”).
I authorize Cubic to collect, use and maintain any Personal Information it deems necessary for the purposes of adjudicating the Request or any purposes in any way ancillary thereto. (Bolding not in original).
This form did not specify limitations as to how this information would be used beyond adjudicating claims, other than as Cubic “deem[ed] necessary,” including for “ancillary” purposes. We do know, however, that some of the services they sell on their website include promises to:
- Reveal hidden financial risks
- Predict high-cost drug claims
- Evaluate what the future holds for a health plan, “based on members and their current health,” and what opportunities exist to “offset risk”
- Reveal hidden time bombs that may result in sudden cost spikes; and
- Flag members who would benefit from early intervention
The Cubic forms used for our members have now been revised to remove this reference to “ancillary” use, but the revised forms still require extremely broad disclosure of medical information to Cubic, and they still require that our members consent to Cubic using and maintaining their personal information “for the purposes of administration … under the FACET Prior Authorization Program.” UBC and Cubic did not notify us of this change in the form, and they have made no commitment not to change it back.
We are appalled that UBC requires our ill or injured members and their dependents to reveal their personal medical information to a for-profit health-data company in order to access coverage that we already had in our previously bargained drug-benefit plan. Our proposal would require the university to negotiate any and all reductions in benefits with us and would ensure that UBC is not unilaterally limiting our benefits or forcing us to provide our confidential health data to outside organizations.
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