I thought I had a good health insurance. I made sure the deductible was affordable and the monthly premium was within my budget. Unfortunately the co-pay for my medication is causing financial hardship. One dose of my medication arrives in four separate boxes and I have to pay separate $20 co-pays for EACH box! It costs me $240 a week to take 3 doses of my factor. Is there anything I can do to change this?
Dear Co-Pay OD,
First, contact your health insurance company and advise them of the problem. There may be something they can do to correct this. Keep a written record of your interactions so you have documentation to support an appeal of their decision if needed.
If they can’t correct what seems to be an obvious problem, you may have no choice but to pay the $240/week for your medication. Check to see whether the annual out-of-pocket limit in your health insurance policy includes co-pays. If so, you may reach your annual limit quickly and will not have to pay additional copays after you reach your limit.
If your insurance policy does not count copays towards your annual out-of-pocket limit and you will be charged a $20 copay/box of medication, then you may want to seek financial assistance. Contact the manufacturer of your medication to find out if there are compassionate factor programs available. Some manufacturers are able to provide a limited amount of factor at no cost. Also, look into co-pay assistance programs which can assist with out-of-pocket healthcare costs.
Click here to see a list of resources that can help connect you with a patient assistance program.
Manufacturers can tell you about the criteria, eligibility guidelines, and other details of their assistance programs. You can find a list of manufacturer assistance programs here.
HFA frequently receives questions from the bleeding disorders community related to advocacy issues. The questions often impact the entire community. In an effort to reach the largest audience possible with our responses to these widely applicable questions, HFA developed “Dear Addy.” Questions submitted to this column are edited in order to protect privacy and should be considered educational only, not individual guidance.