Swimming with sharks

Pharma and insurance companies play devious, clever games, competing for dollars. They’re sharks! It’d be fun to track, but they’re eating us alive.

If anyone could beat the sharks at this game, we’d pick Lillian Karabaic, who runs the personal finance show/community called Oh My Dollar! — and is SUPER on-top-of her stuff. 

But Lillian recently got socked with an unexpected $3,000 charge— and expects to lose her very-organized fight against it.Understanding how Lillian got here — how pretty much any of us could, and how we can start to fight back, together — means understanding the games these big sharks are playing.

Which is exactly what we do in our latest episode, with Lillian’s expert — and often very-funny — guidance. 

This episode goes deep on a shark game called a “copay accumulator” policy. In short, they’re an invention by the insurance industry to make sure only YOUR money counts toward your yearly deductible — not any assistance you may receive from a drug company. 

One thing we learned: Finding out if your insurance plan even includes one of these policies can be extremely tough: Otherwise, Lillian — who did her extremely-good best to check for this very information — wouldn’t have gotten taken by surprise.

We’ve got a little bit of help to offer: Researchers from a nonprofit called The AIDS Institute also researched this question, looking at hundreds of plans across the country. And they developed a tip sheet a tip sheet to help guide their search: How to search online, what questions to ask if the information just isn’t online (which happens).  

More resources:For tips on how to avoid overpaying for drugs — when that’s possible — check out the latest edition of our First Aid Kit newsletter.There’s a third bunch of sharks involved in this drug-pricing game: Middleman companies called Pharmacy Benefit Managers. If you want to understand the role they play, here’s an Arm and a Leg episode about them.A dozen states have banned copay accumulators, and more are considering it. This short report includes a list of those dozen states. 

Here’s a transcript of the episode. 

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