Reference no: EM133343507

Janet just got diagnosed with rheumatoid arthritis, an autoimmune disease that disproportionately impacts women. Janet, 34, was experiencing a lot of pain in her hands and feet prior to the diagnosis and is thrilled her doctor has finally figured out what is wrong, as it was getting difficult to continue her job as a middle school teacher. She was prescribed a biological drug to treat her disease and has health insurance through her job, so she did not think there would be a problem. Her doctor told her that before filling the prescription, she should call her insurance company to make sure the drug was covered and to see if there was a large out-of-pocket expense. Janet was concerned because, as a teacher, she did not have a lot of extra income to be spending on medicine, so she called her insurance provider. The person on the other end of the phone explained that her medicine was, in fact, covered, but that she would have to pay a $50 co-pay for each injection. She was scheduled to get two injections a month, so her annual out-of-pocket costs for the drug were going to be $1200.

1. How should Janet manage the need for this drug to treat her arthritis, with the added expense it will create?

2. What is a co-pay, and why does she have to pay for a drug if its covered by her insurance?

3. Is Janet's experience unusual?