Listen: Ensuring All Copays Count

Recently on Psound Bytes™, the official podcast of the National Psoriasis Foundation (NPF), Julia Boles, NPF grassroots and advocacy manger, and Kristen Stiffler, NPF state government relations manager for the central region, discussed the impacts of a new insurance trend known as copay accumulator adjustment programs.

In the episode, Boles and Stiffler breakdown this new trend so that you can better understand whether or not it could be impacting you. They use an example of a patient named Kelly, whose experience may sound a bit like yours.

For several years, Kelly, like many with psoriatic disease, utilized a copay assistance program to help afford the out-of-pocket costs for her biologic treatment. The copay assistance – which is real money –  counted toward her deductible and out-of-pocket maximum.  

Then, a few months into this plan year, Kelly was suddenly faced with the harsh reality that she would either have to pay $3,000 for 1 month of treatment or go without.

Why the sudden increase? Her insurance company implemented a copay accumulator adjustment program, which stopped her copay assistance from counting toward her deductible. Now, the assistance was used up, but her deductible was not met, so Kelly owed an amount she could not afford.

Many with psoriasis and psoriatic arthritis have found a treatment that works for them. Staying on an effective treatment is essential to managing psoriatic disease and reducing the risk of comorbidities like cardiovascular disease or type 2 diabetes. Unfortunately, high out-of-pocket costs like the ones Kelly experienced threaten your ability to stay on an effective treatment.

To date, 10 states have enacted legislation to ensure that all copays count, and NPF continues to advocate across the country to bring these protections to more states.

If you are concerned that this new trend is impacting you, or if you are experiencing something similar to Kelly and unsure of what to do next, the NPF Patient Navigation Center has a free resource available to you.