Over the course of 2025, Jayant Mishra from Mission Viejo, California, started developing itchy, scaly red patches on his skin. Soon after, he felt pain and swelling in his hand joints, making his banking job tough.
His doctor referred him to a rheumatologist, who diagnosed him with psoriatic arthritis. Although there’s no cure, the rheumatologist suggested a new medication called Otezla. Initially, Jayant hesitated, concerned about the high costs and possible side effects. He thought over-the-counter medications might suffice.
By September, in so much pain that he couldn’t ignore it anymore, he decided to give Otezla a try. The starter pack provided by Amgen worked wonders. The skin lesions vanished, and his joint pain lessened, allowing him to sleep better.
His doctor got approval for the drug from UnitedHealthcare and enrolled him in a copayment assistance program. She explained that the card would cover most of the drug’s hefty cost, which is around $5,000 for a month’s supply. Thanks to negotiated discounts between insurers and Amgen, patients often pay a reduced price—for Jayant, it was around $1,400 to $2,200 monthly, with his copay card covering $9,450 a year.
At first, he paid nothing out of pocket. But then the second-month bill arrived: $441.02, leading him to ration his prescription. UnitedHealthcare’s statement revealed that the copay assistance didn’t count toward his deductible, leaving him responsible for a significant balance.
Aaron Kesselheim, a professor at Harvard Medical School, said this reflects the tug-of-war between drugmakers and insurers. Many insurers don’t count copay card funds toward deductibles, which means patients can end up spending more despite the initial savings. “Using a copay card can result in higher costs overall,” Kesselheim explained.
Caroline Landree from UnitedHealthcare emphasized that copay cards are separate from insurance arrangements. Meanwhile, Amgen’s Elissa Snook pointed out that while these programs help patients initially, their value can run out quickly when insurers charge the full list price.
The situation is typical for many patients in the U.S.; brand-name drugs come at steep costs. Even though generic versions of Otezla were approved in 2021, issues with patents allow Amgen to block sales, keeping prices high until at least 2028. Overseas, the same drug can be much cheaper.
Jayant, with a $5,000 deductible plan and a health savings account, felt the pinch of costs quickly. After exhausting his copay card, he turned to his HSA to cover additional balances. Faced with rising prices, he stretched his pills, often skipping doses. He received another copay card worth $9,450 the following year, but it wasn’t enough. “I was still left with a balance, and my symptoms returned,” he said.
By February, he learned he’d need to pay $4,450 to meet his out-of-pocket maximum for the following month. However, upon querying further, he uncovered the actual charge would be around $6,995.36, a staggering amount for many individuals.
This scenario illustrates how copay cards can create confusion and financial strain. They can make it tough for patients to grasp their true prescription costs and might push them toward pricier brand-name medications instead of generics, which may also provide relief.
Patients often need help navigating these complexities and should discuss budget-friendly alternatives with their healthcare providers. There are often less expensive medications that can effectively treat psoriatic arthritis.
Patient choices at open enrollment can also affect affordability. Jayant realized he could have picked a plan with a more manageable copay for Otezla, which would have resulted in higher premium costs.
While Jayant tries to manage his healthcare expenses, he remarks, “I can afford it, but the sticker shock feels wrong.” The growing complexity of drug pricing calls for better understanding and communication between patients and providers.
For more information on copayment assistance programs and navigating healthcare bills, check out resources from KFF Health News.
