If I take this job, and the plan’s formulary puts that drug in a tier with a coinsurance instead of a copay, I will be worse off than I am today.

I will be earning a hundred and forty thousand dollars and I will not be able to afford my daughter’s medicine.

“I don’t want your eighty-five thousand dollars.

I want somebody in this building to pull the formulary and tell me what tier omalizumab is in before I sign anything.”

There was a silence in that room that I have never forgotten.

And Vivienne Bramhall said, quietly: “I don’t know what tier it’s in.”