Chronic illness sufferers in New Jersey are getting hammered by deceitful copay tactics—enough is enough with this outrageous rip-off! | Opinion
- Opinion (https://www.nj.com/opinion/)
- Published: Dec. 07, 2025, 4:00 p.m.
By
- NJ Advance Media Guest Columnist (https://www.nj.com/staff/NJAMGuestOpinion/)
By Kathleen Hoffmann
As medical expenses keep climbing sky-high, it's squeezing everyone—from hefty insurance premiums that gobble up your hard-earned pay to those surprise charges at the drugstore checkout.
But for individuals grappling with long-term conditions like arthritis, the pressure is downright unbearable. And murky insurance rules are only piling on the misery.
Dealing with a condition that lasts a lifetime isn't just popping a single pill and calling it a day. Many rely on cutting-edge treatments that can set you back hundreds each month. Thankfully, manufacturer and nonprofit copay help initiatives have acted as true saviors, bridging the gap so folks can keep up with their meds and maintain their well-being.
In the past, these aids applied directly to deductibles and annual spending caps, allowing patients to cover initial costs, reach their yearly limits faster, and then qualify for full insurance coverage once the assistance expired.
But here's where it gets controversial—insurers have cleverly rigged the game with "copay accumulator" and "maximizer" strategies that let them snag the value of that help while still expecting patients to shell out the entire deductible themselves. The outcome? Patients end up footing the bill twice: first via the aid that gets swallowed up by insurers, and again from their own wallets.
For those battling ongoing health issues, this isn't merely unjust—it's downright perilous. When therapies become too pricey, people skip treatments, sparking worsening symptoms, accelerated disease advancement, and permanent damage that can't be undone.
And this is the part most people miss: without intervention, we're talking about a public health crisis that could strain our healthcare system even further. Imagine a society where preventable disabilities rise, leading to more lost productivity and higher long-term costs for everyone.
I speak from personal experience. Having lived in New Jersey for over four decades, I received a rheumatoid arthritis diagnosis back in 2008, followed by osteoarthritis and degenerative arthritis. I've endured 11 operations to repair joints and tendons ravaged by inflammation—some necessitated by postponed care. Right now, I'm facing the need for a shoulder replacement surgery due to arthritis-related wear and tear.
I'm part of the 1.5 million New Jersey residents officially diagnosed with arthritis, and I've struggled with exorbitant prescription prices, especially for drugs lacking affordable generic alternatives. As a result, I've frequently depended on copayment support to make my medications accessible.
When I first got diagnosed, that assistance was factored into my insurance's out-of-pocket requirements. Given the steep costs of biologic arthritis medications, I'd typically meet my yearly maximum by February.
Tragically, my insurer abruptly and without any prior notice ceased crediting this help toward those obligations. When I asked about the shift, I learned there was no avenue for appeal.
It's crucial to clarify: copay assistance isn't the same as a coupon or discount that lowers the drug price at the register. It's a genuine payment method, essential for those who couldn't otherwise afford to fill their scripts. Grasping this distinction is key—it's exactly what proposed laws like A5217/S3818 aim to address, by mandating that all such assistance counts toward patient costs, just as it should.
One more critical angle as you weigh this bill: patients shut out from using copay aid might simply can't afford their meds. Choosing to forgo them, particularly for something like arthritis, carries a heavy toll—potentially speeding up illness progression and robbing individuals of their ability to work, engage in hobbies, or contribute fully to community life.
Arthritis stands as the top contributor to disability across New Jersey and the U.S., making it vital that we do everything possible to help those with chronic diseases access vital medications—including guaranteeing that any needed copay support is rightfully applied to their behalf.
New Jersey has the power to rectify this injustice for over 1.5 million residents dealing with arthritis. The proposed patient assistance protection bill (A5217/S3818) would enforce that copay help is properly counted against patients' expenses, restoring fairness.
The Assembly has already taken a stand—thank you for championing patients. Now, it's up to the Senate to follow suit before the lame-duck period wraps up. Each delay means more individuals forced into agonizing decisions about their health.
To our lawmakers: please don't overlook us in the final stretch. Approve A5217/S3818 to shield patients from these damaging insurance tricks. Our well-being—and our very lives—hinges on it.
The best way to make your voice heard is by reaching out to your state Assembly or Senate representatives. Head to the New Jersey Legislature website's Legislative Roster (https://www.njleg.state.nj.us/legislative-roster) to locate your members and share your stance.
Do you believe insurers should benefit from aid meant for patients, potentially profiting at the expense of health? What counterpoints might there be—could these programs inadvertently complicate insurance systems or raise costs for others? Weigh in below and let's discuss: is this a necessary fix for fairness, or does it risk unintended consequences in our complex healthcare landscape?
Kathleen Hoffmann was diagnosed with rheumatoid arthritis in 2008 and has served as a patient advocate with Creaky Joints and the Arthritis Foundation. She is a retired IT professional and currently works as an international travel agent.
