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like Sober living and
halfway houses. Turning to

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health care, we continue our
coverage of prescription

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drugs as drug prices for
patients go up, health

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insurance coverage of them
goes down. In our series Rx

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Uncovered Here and Now,
producer Marissa Wojcik

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unpacks why this is
happening and the impact

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it's having on patients. In
tonight's story, we look at

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how health plans use
accumulators to divert

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financial aid away from
patients in need.

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>> I couldn't believe what I
found out when this

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happened. I couldn't believe
it was legal.

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>> Tamra Varebrook lives
conditions. She can still

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live her life as long as she
has her medication.

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>> I changed jobs and
started over with a new

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copay and new deductible.
That's when this hit me, I

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wasn't getting my
medications. And you know, I

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thought, what? Why aren't
you sending them? They're

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like, well, you have a
$6,000 balance. I had my

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first experience with copay
accumulators. I had never

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even heard of him.
>> A copay accumulator

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sounds like an obscure
insurance term, and it is.

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>> And I know people don't
understand this. If this

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doesn't directly affect
them.

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>> It's also a growing trend
among health plans for

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Tamara's conditions. Her
medication costs her the

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equivalent of buying a car
every year.

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>> Right now, I take the
entire prior year to save

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up, to try to have enough to
buy my drug in January. It's

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ridiculously expensive, but
it's the thing that makes me

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be able to walk in my arms,
bend and, you know, keep,

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you know, my joints moving
so I don't end up in a

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wheelchair.
>> To afford her drugs, her

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doctors told her about
patient assistance programs.

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It's often the drug
manufacturer helping the

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patient to afford their own
high priced medication. This

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kind of financial assistance
is referred to as a copay,

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coupon or copay card.
>> That were meant to help

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the patients get their drugs
and pay down their

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deductibles, pay down their,
you know, on their

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out-of-pocket maximums.
>> Here's how they work a

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patient is prescribed an
expensive name brand drug

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that doesn't have a generic.
Their health plan has a high

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deductible and out-of-pocket
maximum, which they must

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meet before the plan will
cover the drug. The copay

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card provides the financial
assistance to cover the

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patient's deductible and
out-of-pocket max. When

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those are met, the health
plan kicks in and covers all

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or part of the cost that
remains of the drug,

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potentially saving the
patient thousands of

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dollars.
>> It was a life changer. I

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was, you know, pretty low
income at the time when a

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lot of my medical issues
started and I would never

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have been able to afford
these medications.

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>> One day, she realized she
wasn't receiving the life

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changing assistance or her
medication. Tamara was

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blindsided.
>> They weren't shipping it.

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And so I kept calling and
saying, well, why isn't this

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shipping there? Like, you
owe $6,000. And I'm like,

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what do you mean I owe
$6,000?

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>> The drug company had
provided the copay card.

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>> I've already gotten this.
And you know, it should be

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my deductible. At least
should be covered.

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>> The problem was the
financial assistance no

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longer covered her. The
pharmacy told her.

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>> If you don't pay for it
in full, you are not getting

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your medication. And I went
months without.

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>> Tamara had recently
started a new job where her

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health plan contained a
copay, accumulator.

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>> I spent countless hours
on phone calls. I can't even

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tell you how upsetting it
was.

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>> The accumulator is a
relatively new tool used by

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health plans and pharmacy
benefit managers. A copay

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accumulator takes the
financial assistance, the

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copay card, and only applies
it to the total cost of the

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drug. It does not count
towards the patient's

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deductible or out of pocket
maximum. In other words, the

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patient no longer saves
money. The health plan saves

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money by taking the full
amount of the copay card and

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still collecting the
deductible and out-of-pocket

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maximum paid by the patient.
>> This is a very scary

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moment for me, just knowing
a lot of other people with

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Mis.
>> Jim Turk has multiple

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sclerosis or Ms, a disease
that attacks the body's

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nerves. There's no cure,
only treatment.

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>> If you're on drugs, I
mean, that's your lifeline.

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That's something that's
preventing that, or at least

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slowing that down
significantly from

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happening. So they don't
have as much stress in their

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life either. And the stress
in their life can also

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exacerbate the symptoms. So
it's just this vicious

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circle.
>> He's an advocate for

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people with Ms. Knowing the
struggles firsthand.

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>> I look at a list to see
what all the drugs cost.

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Ocrevus the one that I was
on last, which was actually

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the newer drug, was one of
the cheaper drugs. And that

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was, I think, 70 or $80,000
a year, which I can't

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afford. I'm on disability.
>> Having been the recipient

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of copay cards. He stresses
their importance for

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patients to survive.
>> You have to make the

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choice between paying for
your drugs. That might be a

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lifesaver or paying for
groceries. And obviously,

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there's no choice there. Or
paying for rent. And that's

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really what it comes down
to.

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>> And a copay accumulator.
>> They're essentially

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designed to be confusing.
>> Makes that choice even

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harder.
>> I thought, Holy cow.

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Well, in 21 states it is now
illegal, but not Wisconsin.

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>> Other states have
outlawed accumulators, and a

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bill currently in
Wisconsin's legislature

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would as well. At a hearing,
health plans and pharmacy

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benefit managers spoke in
opposition.

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control the soaring prices
of prescription drugs set by

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pharmaceutical
manufacturers, but instead

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rewards drug makers for
steering patients towards

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more expensive brand name
drugs.

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a ploy by pharmaceutical
companies to get patients to

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take expensive name brand
drugs.

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>> Rather than benefiting
those in financial need. A

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lot of these coupons from
manufacturers act as an

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inducement to move to higher
cost products.

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>> Supporters of
accumulators say they lower

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costs by saving health plans
money, not just one patient,

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but others refuted these
claims.

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assistance programs from
manufacturers are for drugs

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with no generic
alternatives. The copay

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assistance increases
medication adherence.

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Studies have found that
morbidity and mortality

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associated with poor
medication adherence cost

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the US healthcare system
$528 billion annual

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Nonadherence can lead to
treatment failure, resulting

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in poor outcomes such as
worsening of condition,

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admission to the emergency
room and hospitalization,

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and requiring new
prescriptions to treat

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subsequent comorbidities,
which results in higher cost

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to the entire health care
system. That is what will

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increase premiums.
>> This rings true for

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Tamra.
>> The specific drug is not

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the only cost of chronic
disease. Chronic disease

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causes people to miss work,
end up in emergency rooms,

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hospital bills.
>> Drug manufacturers do not

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like accumulators because
the assistance doesn't go to

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help the patient. She fears
they may end up not

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providing the assistance at
all.

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>> I'm afraid that the
pharmaceutical companies

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stop the programs because
they're not helping the

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patients, and that would be
a real nightmare because

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then everybody would suffer.
This is where we're at in

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Wisconsin now, and I feel
bad for everybody who has a

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child or, you know, any
adult that runs into these

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issues because most people
are not prepared with that

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kind of money, and you
aren't going to get your

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medication.
>> Reporting from Germantown