Our mission is to improve the quality of life for BIPOC who are affected by IBD, Digestive Disorders and associated Chronic Illnesses; through Community, Research, Education, and Advocacy.

A Real Picture Of Health:
Joshua Denton

“I did everything that I was supposed to do. I went to college. Got a job. I am paying for my health care so why can’t I afford the medication for a condition that I never asked to be diagnosed with?”

 

When Joshua was 25, he enrolled in his employer’s health insurance plan, but his only choice was a high deductible plan which meant that the same medication that he was previously paying $20-25 per month shot up to an unaffordable $600 per month.

 

Josh turned to creative, but potentially hazardous ways to continue to take his medication. Josh resorted to cutting his recommended dosage in half and even went two to three weeks without medication while he waited for his pay check to arrive.

 

He described this as one of the most painful experiences of his adult life. Josh tried to use manufacturer coupons to help with medication costs, but those were hit or miss and didn’t always cover deductibles which can range from $500 to thousands of dollars and eventually expire.

 

Josh feels that insurance companies should be held accountable and coupons should be allowed to cover any and all costs. He would like to see patients maintain their dignity and their quality of life which occurs when they can afford to take their prescribed medication.

Copay Accumulator Program

Many GI patients use co-pay assistance, such as co-pay cards or manufacturer coupons, to pay for their life-saving medications. Pharmacy benefit managers (PBMs) and insurers increasingly use co-pay accumulator programs to prevent such assistance from counting towards patient cost-sharing, such as their deductible or annual out-of-pocket maximum. As a result, patients may struggle to afford and adhere to their medications as insurers and PBMs seek to shift more cost-sharing responsibility to patients.

Pharmaceutical manufacturers often offer copayment cards or drug coupons to patients to help them afford their medication and to minimize their out of pocket costs. These assistance programs help patients by reducing the amount of money that they pay at the pharmacy when their prescription is filled and the value of the coupon counts toward a patient’s cost sharing requirement (e.g. their deductible).

Copay accumulator or copay maximizer programs have emerged as two new programs that unfairly target drugs in which manufacturer assistance is often provided, exposing patients to high out-of-pocket costs. Under these programs, patients can still access their medication, but health plans don’t apply the value of the copayment assistance toward a patient’s deductible.

Copay accumulator programs completely remove the intended benefit of manufacturer assistance programs and remove a safety net for patients who rely on costly medications. Once patients exhaust the value of the manufacturer copayment coupon or card, they must cover the entire amount of their cost sharing requirement before their insurance plan kicks in.

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