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Hi, I was made aware by my insurance company in the last few days of 2016 that copay assistance paid by any third party providers (e.g., Teva via Shared Solutions via Opis Insurance here in the US for Copaxone) would not count toward max out of pocket or deductible for the year, which basically means, I am now responsible for paying 6,500 USD for the medicine until I myself meet the max out of pocket and deductible (they happen to be the same for my policy). I haven't read anything about this in the news and was wondering if anybody else had run into this and if it is an across the board thing or was some individually-based kind of thing. In the past, Shared Solutions would pay up to a certain amount until my max out of pocket was met, otherwise I couldn't afford the drug--now I can't. Has this happened to anybody else?
I have been on Copaxone for 6 years and all of a sudden I am not going to be able to afford it.
Thanks.
elcat9091
You can expect this kind of thing to be happening all over, especially in the U.S. Deductibles have risen dramatically and more and more chronically ill peopke will be expected to pay a bigger portion of their medicine tab. With the coming changes to the healthcare and the insurance regulations and industries this is going to be a big debate and many people will likely struggle to find ways to cope with this. One big movement underfoot is to move people who are considered chronically ill and rely on taking regular, expensive drugs into high risk pools, which likely won't have a happy ending. The only good news is that, as more and more people drop out of the system of being able to afford their medicines, drug prices set by Big Pharma will be under pressure to come down because the burden of payment is going to be shifting from the insurance companies to the consumer. You're just starting to see the early stages of it now. The other thing that is likely to happen is that as more consumers have to pay a much bigger portion of their drug costs there will be more people deciding, do I really need to be taking these drug in the first place.
Yes, that was a decision I had made for myself until I realized that this situation has a loophole which will probably be closed soon enough, so I will be able to continue with the Copaxone, at least for this year at a similar cost to previous years. I think you are right, the chronically ill will get moved into their own pool again, with higher costs for them--it is either them or the insurance companies who pay the bill.
But I was thinking that it does seem like an awful lot of people have MS now and other chronic diseases and are taking medicine for it. We just have to follow the money to see why this is happening.
Your comment was quite insightful. Do you read a lot about this kind of stuff?
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