Chronic Illness Patients in New Jersey Are Being Exploited by Insurance Loopholes—Here’s How We Can Fight Back
Published: Dec. 07, 2025, 4:00 p.m.
By Kathleen Hoffmann, NJ Advance Media Guest Columnist
Healthcare costs are skyrocketing, and everyone feels the strain—whether it’s premiums shrinking paychecks or copays draining wallets at the pharmacy. But for those of us battling chronic illnesses like arthritis, the system isn’t just burdensome—it’s downright predatory. And here’s where it gets controversial: insurers are quietly exploiting loopholes to double-dip into patients’ pockets, leaving us to bear the brunt of their greed.
Managing a chronic condition isn’t as simple as popping a pill. For many, it means relying on cutting-edge treatments that can cost hundreds—even thousands—of dollars each month. Copay assistance programs, offered by manufacturers and nonprofits, have been a lifeline, helping patients afford life-saving medications and maintain their health. Historically, these programs counted toward deductibles and out-of-pocket maximums, easing the financial burden and ensuring patients could access care without going broke.
But here’s where it gets worse: insurers have devised schemes like “copay accumulator” and “maximizer” programs to game the system. These tactics allow them to pocket the value of copay assistance while still demanding patients meet their full deductibles. The result? Patients are forced to pay twice—once through the assistance insurers absorb, and again out of their own pockets. This isn’t just unfair; it’s a dangerous gamble with people’s lives.
When treatment becomes unaffordable, patients are forced to abandon care. For chronic conditions like arthritis, this means flare-ups, disease progression, and irreversible damage. And this is the part most people miss: arthritis is the leading cause of disability in New Jersey and nationwide. Denying patients access to affordable medications doesn’t just harm individuals—it cripples communities and strains our healthcare system.
I know this struggle intimately. As a 42-year resident of New Jersey, I’ve lived with rheumatoid arthritis, osteoarthritis, and degenerative arthritis since 2008. I’ve endured 11 surgeries to repair joint and tendon damage, much of it caused by delayed treatment. I’m now facing a shoulder replacement due to arthritis-induced damage. Like 1.5 million other New Jerseyans with arthritis, I’ve relied on copay assistance to afford my prescriptions, many of which have no generic alternatives.
When I was first diagnosed, copay assistance counted toward my out-of-pocket obligations, helping me reach my annual maximum by February each year. But my insurer suddenly stopped counting this assistance, leaving me with no recourse. When I asked why, I was told there was no appeal process. This isn’t just a policy gap—it’s a moral failure.
Copay assistance isn’t a coupon or discount; it’s a critical form of payment that ensures patients can fill their prescriptions. The difference is crucial, and it’s what legislation like A5217/S3818 aims to address: ensuring all copays count toward patients’ costs. Without this protection, patients face impossible choices: go into debt, skip doses, or abandon treatment altogether. For diseases like arthritis, this can lead to disability, job loss, and a diminished quality of life.
The Assembly has already taken a stand by passing this bill—a move that deserves applause. But the fight isn’t over. The Senate must act before the lame duck session ends. Every day of delay means more patients are forced to choose between their health and their finances.
Here’s the controversial question: Why are insurers allowed to profit from patients’ suffering? Isn’t it time we prioritize people over profits? If you agree, call your state Assembly member or Senator today. Visit the New Jersey Legislature website’s Legislative Roster to find your representative and make your voice heard. Let’s demand they pass A5217/S3818 and protect patients from these predatory schemes. Our health—and our lives—depend on it.
Kathleen Hoffmann is a retired IT professional, international travel agent, and patient advocate with Creaky Joints and the Arthritis Foundation. She was diagnosed with rheumatoid arthritis in 2008.
