Making All Copays Count
Last updated: July 2021
Getting a little outside of your comfort zone is a good thing. Getting way outside of your comfort zone can be nerve-wracking and challenging. But when the National Psoriasis Foundation called on me to step up and share my story with lawmakers, I took a deep breath, said “yes,” and knew that I could make a big difference for patients in Michigan, even though I hate public speaking.
Manufacturer copay assistance
You’ve probably seen psoriasis and psoriatic arthritis medication commercials on TV, and many end with information about how to contact the manufacturer to get help in affording the medication. Both my son and I receive copay assistance for our biologic treatments. If we didn’t, our out-of-pocket costs for our quarterly injections would be about $4,000. Thank goodness for this help!
We aren’t alone. Many patients rely on this assistance. Without it, patients could face such financial trouble that they choose to forgo their medication in order to put food on the table. Unfortunately, this is no exaggeration.
Copay accumulator adjustment programs
Earlier this year, the National Psoriasis Foundation (NPF) asked me to testify in front of Michigan’s House Health Committee about our family’s experience with copay accumulator adjustment programs. My answer: “I’m sorry, what?” Like many of you, I really had no idea what that meant. So, here’s the gist of copay accumulator adjustment programs.
Patients, like us, receive the manufacturer copay assistance, and that is usually a large chunk of what they would have to pay out of pocket. For us, that is our entire copay, minus $5 for my son and $5 for me. The manufacturer pays the remaining balance of our copay.
That’s great for us until you look closer and examine how our insurance company is calculating it. You see, even though the drug company pays our copay balance, the insurance company doesn’t count it toward our deductible or out-of-pocket annual totals. That means until we meet our plan’s limit, we still have to pay.
It shouldn’t matter where the money comes from, as long as the bill is paid. But the insurance company gets to double-dip. They get paid twice: once from the drug company and once from us — over time, during the year.
Gathering the numbers
After NPF explained this to me, I emphatically agreed to testify. During our pre-testimony research, we discovered that had this copay accumulator adjustment program not been in place, my 2018 gall bladder surgery would have been far less expensive for me because I most likely would have already met my deductibles and out-of-pocket maximum prior in that year. As you can imagine, I was very angry.
After being postponed twice, I finally got to testify virtually in front of Michigan lawmakers.
Even though our group represented psoriasis and psoriatic arthritis communities, it is important to note that copay accumulator adjustment programs reach across all health conditions. Passing House Bill 4353 would help all Michiganders who use copay assistance by making sure that all copays count.
Thankfully, the representatives agreed and the committee passed it. In fact, the whole state House passed the bill. It is currently in the state Senate. We are very hopeful that this gets passed on a state level, but it would be even more impactful if it gets passed on Capitol Hill. Until then, I will take pride in knowing that I did what I could to get lawmakers on the side of patients to make sure all copays count.
Learn more about copay assistance and request a free NPF resource that illustrates how these accumulator programs negatively affect patients.
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