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Over the course of 2025, Jayant Mishra of Mission Viejo, California, progressively developed scaly, itchy red patches on his skin. Then came the pain and swelling in the joints of his hands, making it difficult to do his work at a bank.<\/p>\n
His primary care doctor referred him to a rheumatologist, who diagnosed psoriatic arthritis. She advised Mishra that while there\u2019s no cure, there were many new medicines that could keep the autoimmune disease in check, and she recommended one, Otezla.<\/p>\n
At first, Mishra balked. He knew the medicines were expensive. He worried about side effects. He thought he could manage with over-the-counter drugs.<\/p>\n
But by September he was in so much pain that he agreed to try a starter pack provided by Otezla\u2019s manufacturer, Amgen. It worked: The skin lesions disappeared, and the joint pain that kept him up at night dissipated. He was sold.<\/p>\n
His rheumatologist got approval for the drug from his insurer, UnitedHealthcare, and signed him up for Amgen\u2019s copayment assistance program. Having enrolled other patients, she told Mishra the copay card, similar to a credit card, should last a year, he said, shielding him from the drug\u2019s high list price: around $5,000 for a 30-day supply, according to GoodRx<\/a>.<\/p>\n He said the doctor explained that, in her patients\u2019 experience, insurers and their pharmacy benefit managers negotiated a deeply discounted price with Amgen \u2014 she estimated $1,400 to $2,200 a month. Patients paid a percentage of that amount, their \u201cpatient responsibility,\u201d using the copay card.<\/p>\n Mishra said he was approved for a copay card covering $9,450 a year. \u201cI was happy when I got the message,\u201d he said.<\/p>\n He added that the doctor reassured him about the cost. \u201cShe said: \u2018You shouldn\u2019t have to pay anything out-of-pocket. Your copay card will cover this.\u2019\u201d<\/p>\n He started the medicine and, at first, paid nothing.<\/p>\n Then the bill came.<\/p>\n