Making Copays Count in Your State

Written by Ryan Precht

In the arthritis community, we know that medications can be expensive. I have had arthritis since I was just 2 years old, and my treatments have run the gamut of costs. From $20,000 for an in-office infusion, to $4,000 for at home infusions, I’ve seen it all.

As an adult, I treat my arthritis with home infusions, which cost around $5,000. Fortunately, I learned about a manufacturer copayment assistance program that covers most of that cost, leaving me with a manageable $50 payment each month. Without this program, affording my treatment would be impossible. Learning about this program helped me get the care I need, and I wish all patients knew about these options for coverage.

Unfortunately, the federal government recently finalized a regulation that says insurers have the right to exclude payments made by manufacturers from counting towards a patient’s deductible out-of-pocket costs. This is known as an accumulator adjustment program and is becoming more common practice among insurers. This was a huge blow to the patient community and the millions of Americans who rely on medications that do not have a cheaper alternative, like a generic, to treat their serious illness. The good news is that the federal government is still allowing states to regulate these practices. This means that if a state passed a bill banning the use of an accumulator adjustments program, insurers would not be allowed to exclude manufacturer assistance from applying to my out-of-pocket costs.

For those reasons, I am eager to help advocate for state solutions to this problem. Currently, only 4 states have passed legislation impacting these programs. In my home state of Ohio, the Arthritis Foundation is hard at work on legislation that would require insurers to count payments from a charity, drug manufacturer, or other third-party toward your out-of-pocket deductible. This legislation is critically important for arthritis patients. The Arthritis Foundation is working on solving this issue in your state too.

Have you ever used a copayment assistance program? Sharing your story can help the effort. If you have had experience with using copayment assistance, please consider sharing your story in our Arthritis Story Bank. Your voice could help this important legislation get passed in your state and connect you to new opportunities to share your story.

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