Hi, my name is Nadine and I'm creating this GoFundMe to help my husband and I deal with the cost of my psoriatic arthritis medication. It's a long story, but I'll try to keep it brief.

A few years ago, I was diagnosed with Psoriatic Arthritis, a chronic autoimmune disease. Like other forms of arthritis, there is no cure, and the only thing I can do is manage symptoms and prevent joint damage. The way I do that is through diet, exercise, and a form of injectable medications called biologics. A biologic is an injection to help stop my immune system from attacking itself. The biologic I need is called Humira; it's a bi-weekly shot that costs $4-6,000 USD PER MONTH.

In the beginning of January, I was told that my refill for Humira would cost $6,000. Humira's assistance program would pay $4,000, and I was stuck with the other $2,000; not ideal, but that $6,000 hit my insurance's Out of Pocket Maximum for the year, and I had no other options (I did not qualify for Abbvie or Prudent Rx). I agreed to pay $2,000 in payment plans for my January/February refill of Humira, and they accepted $4,000 from Humira's assistance program.

BlueCross BlueShield/CVS Caremark accepted the money from Humira as a copay assistance for my specialty medication, but then altered my bill that same week and informed me that since my medication is listed on a non-essential health benefit list, the monthly cost of my medication does not count towards my yearly deductible and out-of-pocket maximum. Because of how BCBS/CVS altered my bill and processed my insurance claim, Humira's assistance program can no longer provide me with any assistance until 2026. Which means 11 months of paying out-of-pocket for my medication; this means I can be expected to pay up to $65k this year for Humira (1 month of medication costs up to $5,907.56 and I need this medication every month, the next 11 months of 2025 = a cost up to $64,983.16).

What they are doing is called a Copay Accumulator Adjustment Program (CAAP), and it's a strategy health insurance companies use to make double money. What they do is accept money from drug manufacturers but do not count it towards the patient's deductible or out-of-pocket maximum, forcing patients to pay extra after using up their assistance money. These CAAPs are illegal in 12 US States, but unfortunately still legal in others.

I've tried other medications, but they did not work for me like Humira does.

I genuinely don't know what to do. I called my insurance almost daily in January, I posted on Threads and TikTok for advice and suggestions, and this is the last resort. I'm already late in my shots, and I feel the pain in my joints getting worse. I don't know what else to do but ask for help. I've reached out to different state departments to see if they can help, but insurance companies have little to no regulation. Even contacting the State's Attorney General doesn't guarantee anything. I have complaints filed against BCBS/CVS Caremark, but I need my medication and I don't have thousands of dollars lying around..