I too have MS, but am able to use the patient assistance program for the co-pay. I was furious several years back when prescription drugs no longer counted towards our deductible. I'm so angry.
No, the exact opposite. The co-pay doesn't apply to the deductible, but it used to. I don't know why it matters whether I'm paying or a company is, other than the goal is to harm patients.
"Essentially, the insurance company is double-dipping; they do not have to pay for the portion saved by the coupon, but they still collect the extra $1,000 from your out-of-pocket maximum."
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To be clear, insurance companies are not 'collecting' the extra $1000 from your out of pocket maximum. The coupon just doesn't count towards it. The copay accumulator program was designed to keep the cost down for the employers of our country - where over half of America gets their coverage.
When the insurance company and the required pharmacy are one and the same company (Aetna is owned by CVS for example), we're already past shady. They determine what they'll cover, where they will cover it, what the OOP minimum/maximums are for patients and then tell the drug company 'patient has a $5,000 deductible', take the 5,000, but not apply it to the patient's deductible and make the patient 'RE-earn their deductible like everyone else' (Sarcasm sorry). Of course 'everyone else' means everyone who is healthy and fortunate enough not to be in dire need of a specialty drug with high efficacy and no generic equivalent. If we're going to criticize specialty drug patients for having assistance count toward their deductible, then let's talk about taxing the portions of premiums paid by the employer as income. I'm just being a devil's advocate. I'd throw all of this out and give us all of our time and lives back by moving this country to Single payer.
Jed Bartlet would just militarize the nation (including conscripting every politician's children) and add folks to TRICare under the #SenateCareForAll program. Any balkers among the stockholder capitalists would be disqualified from any DoD contracts.
I too have MS, but am able to use the patient assistance program for the co-pay. I was furious several years back when prescription drugs no longer counted towards our deductible. I'm so angry.
are you saying that the patient assistance program covers the co-pay now to cover the deductible that was no longer covered?
No, the exact opposite. The co-pay doesn't apply to the deductible, but it used to. I don't know why it matters whether I'm paying or a company is, other than the goal is to harm patients.
"Essentially, the insurance company is double-dipping; they do not have to pay for the portion saved by the coupon, but they still collect the extra $1,000 from your out-of-pocket maximum."
_____________________________________
To be clear, insurance companies are not 'collecting' the extra $1000 from your out of pocket maximum. The coupon just doesn't count towards it. The copay accumulator program was designed to keep the cost down for the employers of our country - where over half of America gets their coverage.
When the insurance company and the required pharmacy are one and the same company (Aetna is owned by CVS for example), we're already past shady. They determine what they'll cover, where they will cover it, what the OOP minimum/maximums are for patients and then tell the drug company 'patient has a $5,000 deductible', take the 5,000, but not apply it to the patient's deductible and make the patient 'RE-earn their deductible like everyone else' (Sarcasm sorry). Of course 'everyone else' means everyone who is healthy and fortunate enough not to be in dire need of a specialty drug with high efficacy and no generic equivalent. If we're going to criticize specialty drug patients for having assistance count toward their deductible, then let's talk about taxing the portions of premiums paid by the employer as income. I'm just being a devil's advocate. I'd throw all of this out and give us all of our time and lives back by moving this country to Single payer.
Your timing for this share today is great. Just two days ago, a federal judge declared it unlawful to deny application of copay assistance to a patients deductible and out of pocket maximum. The plaintiffs one in the civil case and the judge ordered HHS to restore the language to 2020 interpretation. Here is a link: https://www.morningstar.com/news/marketwatch/20231002268/court-strikes-down-federal-rule-that-sharply-increased-prescription-costs-for-many-patients
Jed Bartlet would just militarize the nation (including conscripting every politician's children) and add folks to TRICare under the #SenateCareForAll program. Any balkers among the stockholder capitalists would be disqualified from any DoD contracts.
One of the best shows on TV, ever