Copay Assistance Is Meant To Defray Patient Drug Costs. Some Insurers Keep It Instead

07 Jul 20264 min read0 viewsVerified Feed

GIST (Key Takeaways)

For 16 years, Larry Gruber, a fitness coach from Wilton Manors, Florida, received a coupon card to help him pay for a psoriatic arthritis medication he needs that costs more than $7,700 a month. Are you struggling to afford your health insurance?
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Each year, Amgen, which makes the drug, called Enbrel , sent the coupon card worth thousands of dollars, and that counted toward Gruber’s health insurance deductible and out-of-pocket maximum. Using the card, Gruber usually met that maximum by February, leaving his health insurance to fully cover his in-network medical costs and reducing his cost for the drug to $0 for the rest of the year.
But this year, his new health insurer, Oscar HMO of Florida , pocketed the coupon card and required Gruber to pay for the drug until he satisfied the cost-sharing requirements on his own.