He Needs an Expensive Drug. A Copay Card Helped — Until It Didn’t. - KFF Health News - Summary - MDSpire

He Needs an Expensive Drug. A Copay Card Helped — Until It Didn’t. - KFF Health News

  • By

  • Elisabeth Rosenthal

  • February 27, 2026

  • 0 min

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Objective:

To illustrate the challenges faced by patients using copay assistance programs for expensive medications, focusing on the case of Jayant Mishra and his experience with Otezla, while also highlighting broader implications for patient access to affordable healthcare.

Key Findings:
  • Mishra's copay card initially covered a significant portion of Otezla's cost, but its value was quickly exhausted.
  • Insurers often do not apply copay assistance towards deductibles, leading to unexpected out-of-pocket costs for patients.
  • The high list price of medications in the U.S. and the complexity of insurance negotiations complicate access to affordable treatment, impacting many patients beyond Mishra.
Interpretation:

The case highlights the financial strain on patients relying on copay assistance programs, which can be undermined by insurance policies and the high cost of medications, reflecting systemic issues in healthcare access.

Limitations:
  • The article focuses on a single patient's experience, which may not represent the broader population's challenges, and lacks diverse patient perspectives.
  • It does not provide comprehensive data on the prevalence of similar issues among other patients.
Conclusion:

Mishra's experience underscores the need for greater transparency in drug pricing and insurance coverage, as well as the potential pitfalls of relying on copay assistance programs. Specific policy changes are necessary to improve patient access to affordable medications.

Original Source(s)

He Needs an Expensive Drug. A Copay Card Helped — Until It Didn’t. - KFF Health News

  • by Elisabeth Rosenthal

  • February 27, 2026

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