Overview

Insured Floridians pay for health insurance with the expectation that they will be able to afford treatment when they or someone in their family gets sick. However, many Florida patients still face barriers to the care they need, especially for patients living with chronic conditions such as cancer, epilepsy, lupus, hepatitis and rheumatoid arthritis.

Patients living with chronic conditions often rely on expensive mediations to live full, healthy lives. To help patients afford their medications, many drug manufacturers and non-profit organizations have implemented copay assistance programs, where cards or coupons are given to cover the cost of care. Although copay assistance can be extremely useful to patients, insurance companies have started implementing copay accumulator adjustment programs.

Copay accumulators stop copay assistance from counting towards a patient’s deductible or out-of-pocket maximum, leaving patients with high medical costs, and forcing them to choose between their health and financial stability. Urgent reform is needed now to ensure that all copays count towards the costs of drugs and medications and protect patient access to the care they need. FAIRx will continue to fight to reduce patient barriers to healthcare.

“I live with multiple sclerosis and struggle with insurance coverage issues that make managing my condition even more difficult. Not only do I have high out-of-pocket costs to get the medications I need, but I’ve had to fail to get results from first step medications before the insurer would consider a stronger one.” – Mary M., West Palm Beach, FL