One such restriction that has impacted Brooke’s family is called a “copay accumulator,” in which any copay assistance would not count, or accumulate, toward the family’s deductible. Over the past several years, PBMs have implemented restrictions that put more of the costs of specialty medications on patients such as Brooke and her family. “We were not educated to know and listen to some of the cues, and we did not treat my son, because treating him would be costly.” Her choice: she didn’t immediately take her 9-year-old son, Kason, who has von Willebrand disease, to the doctor when he complained about shoulder pain after he had fallen on the playground. “Unfortunately, in the last six months, I was hit with the fact that I had made a bad mom choice.” “I can count numerous times where we’ve had to pick between getting groceries for the week or doing a treatment,” Brooke said. ![]() Now her daughter, Katy’s, most recent copay was $5,000 for four weeks of medicine. I didn’t/still don’t feel I understand any of this mess. “Originally, we thought it would make more sense, but this may have been an uneducated decision. “We needed to meet the deductible to assist with all the other appointments and meds we utilize as a family,” she said. The family has a high-deductible plan through the employer of Brooke’s husband: $9,100 for an individual and $18,200 for the family, the out-of-pocket maximums set by the Affordable Care Act. (The family’s specialty pharmacy is Accredo).īrooke and her family decided not to use the copay assistance because it did not count toward their deductible. “When that ran out, our portion was about $300 a week,” she said.īut Blue Cross Blue Shield of Alabama, Brooke’s insurance company, and the PBM Express Scripts changed its policy and have implemented a program so the copay assistance doesn’t count toward the family’s deductible. In previous years, Brooke said they would use the copay card when it counted toward their out-of-pocket deductible. It’s expensive but CSL Behring, Humate-P’s manufacturer, offers copay assistance of $10,000 a year. Two of Brooke’s children take Humate-P, a von Willebrand factor/factor VIII replacement therapy. Brooke and three of her eight children have been diagnosed with von Willebrand disease, which is a bleeding disorder that is characterized by low levels of von Willebrand factor, a protein that helps blood clot. ![]() Because of the cost, she has made the decision to focus on treating her children instead. Brooke Loving doesn’t take the medication that would keep her von Willebrand disease under control.
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