PARK CITY, Utah — Imagine being diagnosed with what’s typically considered a terminal disease. There is a medication to keep you alive, but when your prescription is canceled, the insurance company says they will no longer cover the cost.
“Me being a macho, mid-30s guy, I said, ‘I’m not going to the emergency room, I’m sure it’s fine,’" Sivak recalled. And he said, ‘No, I called ahead, they’re waiting for you, you have a room ready.’ And that’s how you find out you go from ‘I’m healthy’ to ‘you’ve got raging cancer.’” “2022, halfway through the year, Regence said, ‘We screwed up and we’re going to redo all your bills. That money, that $15,000, doesn’t count.’ And they redid all my bills and I immediately got letter after letter saying, ‘You’re passed due, you’re passed due, you’re passed due.'”
Unfortunately, he, along with thousands of Utahans, experience copay accumulator adjustment. That’s when insurance companies and pharmacy benefit managers, or PBMs, keep the co-pay assistance meant for a patient and use it for more profit.During last year’s legislative session, Sen. Evan Vickers authored a bill that aimed to combat the very issue and to keep money in patient’s pockets.This year, Sen. Curtis Bramble is taking on a similar measure and hoping for a different outcome.
Imagine that we are still beholden to private healthcare companies. It’s a joke.