Health Insurers’ “$0 Copay” Drug Assistance Scam
Drugmakers offer “copay assistance programs” to help people afford expensive medicines. But health insurers are milking these programs for billions of dollars in extra profits while denying patients the benefits they were designed to provide.
Health insurance companies are potentially making billions in additional profits from drug copay assistance programs while denying patients some of the benefits they were designed to provide. (Igor Golovniov / SOPA Images / LightRocket via Getty Images)
Last year, Heather Bryan was diagnosed with a rare form of blood cancer, for which she was prescribed Cotellic, a pill that slows the spread of cancer cells. The medication alleviated some of her most serious symptoms, but it cost almost $7,000 a month.
Thankfully, Cotellic’s manufacturer offers a copay assistance program that brought her monthly cost down to zero. Under the program, the drug manufacturer was supposed to cover the “out-of-pocket costs” for her medication up to $25,000, or just over three months of Bryan’s prescription. Since her insurance plan’s annual out-of-pocket cost was only $12,000, her insurance should have covered the rest of her medical costs for the year.
The arrangement seemed too good to be true — and in the end, it was.
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