Tricia’s story is like many others trying to make arthritis coverage more affordable
My name is Tricia Mershon, and I live with my family in Corona, California. At the age of 3, my daughter, Rachel, was found to have a dysfunctional immune system. Her tiny body failed to mount a response to infection, and various disease specialists were able to document the phenomenon but unable to pinpoint a cause.
就在九年级之前，瑞秋的手指弯曲成一个有趣的s形，看起来和其他人都不一样。当她的脚、膝盖和臀部开始疼痛，有时导致行走困难时，蕾切尔立即被转到风湿病科，我们找到了真正的罪魁祸首。14岁时，蕾切尔被诊断患有幼年特发性(类风湿)关节炎。She began aggressive treatment to halt the progression of this insidious disease.
“Copay assistance saved us financially and helped my daughter access the care she desperately needs.”
Like many families with loved ones taking a specialty medication, we have relied on copayment assistance to help my daughter access her medicine. Without her biologic, she couldn’t be as active as she is today. But when my husband changed jobs, we enrolled in a high-deductible health plan, which has a higher deductible than a traditional plan. Although the monthly premium is lower, you must pay your share before your insurance kicks in. Copay assistance saved us financially and helped my daughter access the care she desperately needs.
Recently, we faced a barrier we’d never experienced before: an accumulator adjustment program.We were using a pharmaceutical copay card, which used to count toward satisfying the deductible. But this year, we discovered that was no longer the case. After filling our first prescription, not one cent of it counted toward our out-of-pocket spending. To add insult to injury, we weren’t notified of the change until almost two months into the plan year, and our accumulator adjustment program ONLY applies to specialty medications – the most expensive tier in prescription drug plans. With this realization, I immediately deactivated the copay card.
“Accumulator adjustment programs basically render copay assistance worthless.Since the medication is so expensive, benefits would be exhausted within 2-3 months with $0 counted toward our out-of-pocket spending.”
但我们的故事并没有结束。药房在我们不知情或未经允许的情况下重新激活了我们的银行卡。因此，我们不得不自掏腰包支付额外的费用。由于没有仿制药或生物仿制药可以替代我女儿的生物药，这项政策改变不允许共同支付援助从我们的免赔额中扣除，将使我们每年多花费7350美元!
这不仅仅是治疗费用的负担。为了解决这个问题花在电话上的时间太多了。在试图让我们的女儿在药物治疗下保持稳定的同时，我们还必须弄清楚如何独自操纵蓄能器调节程序。
“We cannot state forcefully enough how concerned we are about how Rachel will be able to afford her medication once she is an independent adult.”
Rachel, now 21, is a college student. Due to her hard work in high school, she earned the Arthritis Foundation’s Winterhoff Scholarship! Over the past several years, we’ve developed relationships with our legislators, going to Washington, DC, and the state capitol in California, to advocate for those with arthritis. The Arthritis Foundation’s training has been invaluable, helping Rachel find her voice to tell her story with confidence.
If your family has an experience that sounds like mine, sharing your story is so important. You can join us in helping raise awarenessto others who might be going through this.
Here are some actions you can take:
- Share your story through the Arthritis Foundation!Your experience keeps us better informed to help us advocate together. TheLive Yes! Arthritis Networkbrings us all together.
- Consult your health plan materials and call your insurer to ask questions.If you have been affected by this type of policy and have had to switch to another drug, or have been unable to fill your prescription, tell your insurer. They won’t know unless you tell them.
- Tell your employer, too. They may not understand the negative impact it could mean for their employees and dependents. Contact your organization’s human resources or benefits specialists.
- If you are unable to afford your prescription drugs,patient assistance programsmay help. Visit the Arthritis Foundation’sAccess to Care toolkitfor help navigating all aspects of health coverage.