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As a small business owner, I’m completely dependent on my physical health to manage the restaurant I own in Stevens Point. As an individual with a complex health condition, I’m completely dependent on my medication to stay on my feet.
But today, my health and the livelihood of my 30-year business are in jeopardy simply because my insurance company is changing the rules on the copay assistance I used to rely on to afford my prescription. It’s a discriminatory practice that Wisconsin legislators can and should address to help vulnerable patients across our state manage their health.
Over six years ago, I was diagnosed with psoriasis and, subsequently, psoriatic arthritis, a chronic, inflammatory joint and skin disease that limits my physical activity. As my condition worsened, my doctor prescribed a brand medication to treat my severe discomfort and joint pain. Like many patients with chronic and complex conditions, I turned to copay assistance to afford my copay, which was $1,600 a month even with my top-tier insurance.
Initially, I was fortunate enough to apply and qualify for copay assistance, which helped me afford and access my treatment and continue my work at the restaurant. However, when my copay assistance ran out, I was completely blindsided when I got a bill for the full $1,600 copay. I found out the copay assistance had done nothing to help me pay down my deductible for the year. Without any warning, I was now on the hook for the entire copay amount and forced to choose between my physical health or financial ruin.
I’m not alone in this scenario. Health plans in Wisconsin are more frequently implementing “copay accumulator” policies, which don’t count the value of copay assistance towards a patient’s annual deductible or out-of-pocket cost limit. In Wisconsin alone, eight out of 13 health plans instituted a copay accumulator policy in 2022. When my copay assistance ran out, I had to discontinue treatment because I could not afford the full copay amount. That was a year ago.
While my husband and I have worked tirelessly to manage our restaurant for nearly three decades, the pandemic inevitably impacted our business. And now, unable to afford my copay cost, I have now been without my medication for over a year. Unmedicated, my psoriatic arthritis can make the daily, necessary tasks of running a restaurant unbearable. I’m just dreading the day when my condition might worsen to the point where I am unable to work, and I may have to make difficult decisions about the future of my business.
Fortunately, there is now legislation before the Wisconsin Legislature that would fix this problem by requiring health insurers to count the value of copay assistance towards patients’ cost-sharing responsibility. This bipartisan legislation has support from over 40 lawmakers on both sides of the aisle, as well as nearly 50 patient and provider advocacy groups. I implore Wisconsin lawmakers to take action on Assembly Bill 103 and Senate Bill 100 to ensure patients like me can access the treatments we need to survive and make a living.
Health insurers are intentionally providing empty health insurance coverage that does not benefit patients when they need it most. By not counting the value of copay assistance towards patient out-of-pocket costs, health plans are forcing patients into challenging financial and life-threatening predicaments where we cannot afford medically necessary treatments. It’s just not right.
Renée Simono is a small business owner, a patient living with psoriasis and psoriatic arthritis and a 30-year resident of Stevens Point.
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