BY LYNNE KINST SPECIAL TO THE SACRAMENTO BEE
JULY 11, 2024 6:00 AM

My late father was born with hemophilia B, a hereditary bleeding disorder that requires regular infusions to control bleeding episodes. Infusions made life possible for him, but it was always a fight with the health insurance plan to get them covered. Seeing him in severe pain, as his insurer refused to cover a medically necessary treatment, drove me into the advocacy work I do today.

Legislators and regulators need to understand what patients go through every day to survive. Looking at the financial hardships alone, even with health insurance, many patients must hit certain cost-sharing amounts, like a deductible, before their insurer will start to cover their medical bills. Deductibles range from an average of $1,500 to $7,000 per year if the patient is enrolled in a high deductible plan. That means a patient would have to pay out-of-pocket for all health care received until they reach the deductible, at which point the insurer would start to cover the cost of treatment.

Californians living with hemophilia face treatment costs that may exceed $50,000 per year, yet many can’t afford a $50 copay. Research shows that nearly 70% of patients in commercial health plans won’t start treatment at all if the out-of-pocket costs reach $250.

It’s no surprise that many patients struggling to afford critical care turn to financial assistance programs for help. These programs, offered by charitable organizations and pharmaceutical manufacturers, cover copays and other expenses for eligible patients for a limited time by making payments directly to the health plan on the patient’s behalf. Although insured patients shouldn’t have to rely on third parties to survive, I cannot overstate how critical these programs have become for those who live with complex conditions and are already struggling to make ends meet.

CLICK HERE to read the rest of this opinion piece about copay accumulator adjustors.