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Point of View: Make co-pay assistance count toward deductible, out-of-pocket expenses

One of the most difficult experiences of my life was watching my grandpa “papa” struggle with complications from rheumatoid arthritis. From my earliest childhood memories, we were cautioned to be careful around him. His pain was so great that we could not even climb on his lap. I learned to be gentle and aware of others’ pain from a very early age.

When I was a teenager, he and my grandma transitioned to living in a nursing home. At this point, he was in so much pain he could not move. But he was alert and had a strong awareness of the world around him. It was terrible to watch, knowing that I could not do anything to help him.

That’s why when I was diagnosed with psoriatic arthritis (PsA) nearly 15 years later and my mother, his daughter, was diagnosed with rheumatoid arthritis, I knew I wanted to do everything I could to help.

One of the biggest challenges of having a chronic condition like PsA is the cost of prescription drugs to manage these painful, debilitating conditions.

However, those treatments can be expensive. In recent years, I’ve taken advantage of co-pay assistance programs that provide coupons to cover some of the cost of care. This has helped me keep my costs low and allow me to stay on medication that enable me to work and live a productive life.

Imagine my shock when my pharmacist informed me that my insurance company was no longer counting the contribution of co-pay cards toward my deductible. That single medicine I was picking up that day — just one of at least six I regularly take — costs $500 a month. Until that day, my co-pay assistance had always counted toward my deductible and out-of-pocket maximum!

I reached out to my rheumatologist to explain my dilemma. We had to decide if I should apply for additional patient assistance programs or seek another medication that might not be as effective, which would include prior authorization and more delays. The back and forth between the rheumatologist’s office, my insurance company and the pharmaceutical company takes time away from my work and school, from my family and myself. It brings added stress to my body that is already in stress due to my medical condition.

I am not alone, and my story is far from unique. Across our great state, people from all walks of life who deal with chronic conditions, and whose lives are improved through innovative treatments are facing this same challenge.

The good news is that our legislators can do something to help address surprise bills that Oklahomans like us have faced. They can pass Senate Bill 92 and House Bill 2678 to help stop the practice of co-pay accumulator programs, which allow insurers to refuse to count co-pay assistance program payments toward patients’ out-of-pocket maximums.

Both bills, SB 92 and HB 2678, are waiting to be scheduled for floor debate in their respective chambers. For the sake of people like me and in the memory of Papa, I urge lawmakers to move swiftly to help Oklahoma patients get the relief they need now.

— Ashley Krivohlavek is from Claremore.