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War over drug-cost assistance traps sickest patients in the middle

When Mike Gartner was shopping for health-insurance coverage early this year, he did his homework. Gartner, a software engineer in Philadelphia, relies on financial assistance from drugmaker AbbVie ABBV, +1.03% to pay for the Crohn’s disease treatment Humira, and he knew that an obscure provision buried in a growing number of health insurance plans could have severe financial consequences for him. These “copay accumulator adjustment” provisions can sharply increase out-of-pocket costs for people relying on drugmakers’ or other third parties’ financial help to cover the costs of pricey specialty medications, because they don’t count that financial assistance toward the dollar amounts patients must spend before their insurance benefits fully kick in.


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