Man Struggles with Costly Medication Despite Copay Assistance

Jayant Mishra's experience highlights the complexities of copay cards and drug pricing in the U.S. healthcare system

Published on Feb. 27, 2026

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Jayant Mishra, a California resident, was prescribed the expensive medication Otezla to treat his psoriatic arthritis. While a copay assistance program initially covered most of the cost, Mishra soon found himself facing hundreds of dollars in out-of-pocket expenses as his insurer and the drug manufacturer clashed over pricing and coverage.

Why it matters

This case illustrates the ongoing tug-of-war between drug manufacturers and insurers over the use of copay assistance programs, which can leave patients caught in the middle and facing unexpected costs for their medications. It also highlights the challenges patients face in navigating the complex U.S. healthcare system and finding affordable treatment options.

The details

Mishra was prescribed Otezla, an expensive medication for his psoriatic arthritis, and enrolled in the drug manufacturer's copay assistance program. Initially, the program covered most of the cost, but after a few months, Mishra found himself owing hundreds of dollars out-of-pocket as his insurer, UnitedHealthcare, and the drug manufacturer, Amgen, disputed the negotiated price and coverage. Mishra was forced to ration his medication to stretch it out, leading to a return of his symptoms.

  • In September 2025, Mishra started taking Otezla and used the copay card to cover the first month's supply.
  • In October 2025, Mishra's copay card was depleted, and he had to pay $441.02 out-of-pocket for the second month's supply.
  • In January 2026, Mishra received a new copay card, but it was still not enough to cover the full cost of the medication, leaving him to pay an additional $550 out-of-pocket.

The players

Jayant Mishra

A California resident who was prescribed the expensive medication Otezla to treat his psoriatic arthritis.

UnitedHealthcare

Mishra's health insurance provider, which is a subsidiary of UnitedHealth Group.

Amgen

The pharmaceutical company that manufactures Otezla and offers a copay assistance program.

Optum Rx

UnitedHealthcare's pharmacy benefit manager, which is another subsidiary of UnitedHealth Group.

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What they’re saying

“When you purchased your medication a Manufacturer Coupon was used," Mishra's explanation of benefits statements read, in tiny letters. The amount the copay card covered "was not applied towards your Deductible and Out of Pocket Maximum.”

— UnitedHealthcare, Spokesperson (gilmermirror.com)

“Copay assistance programs are designed to help patients start and stay on prescribed therapy, but the value of that assistance can be exhausted more quickly when a health plan requires patients to pay the full list price of a medicine.”

— Elissa Snook, Spokesperson for Amgen (gilmermirror.com)

“Personally I'm not in financial distress — I can afford it," Mishra said. "But it was sticker shock, and it just doesn't seem right.”

— Jayant Mishra (gilmermirror.com)

What’s next

Mishra plans to review his health insurance options for 2026 to find a plan that provides better coverage for Otezla, even if it means paying a higher premium.

The takeaway

This case highlights the complexities and limitations of copay assistance programs, which can leave patients unexpectedly facing high out-of-pocket costs for their medications. It underscores the need for greater transparency and alignment between drug manufacturers, insurers, and patients to ensure affordable access to essential treatments.