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EPIC

Overview

T + T

Background

HISTORY

The Elderly Pharmaceutical Insurance Coverage Program (EPIC) is a New York State prescription plan that began in 1987 and operates as supplemental prescription coverage to Medicare Part D prescription coverage for seniors 65 and over.

Previous to 2006, EPIC operated as comprehensive prescription plan for low and moderate income seniors. With the implementation of the Medicare Part D prescription benefit, the EPIC program began to slowly evolve to provide better coordination of services with Medicare Part D. However, in January 1, 2012, the EPIC program underwent a significant change when it began to provide a much more limited supplement prescription drug coverage to Part D; wherein benefits were only provided during Medicare Part D’s coverage gap, the so-called “donut hole”. Subsequently, NYS restored much of the EPIC program with the passage of new legislation in April 2012 that became effective January 2013.

Currently EPIC offers supplement prescription coverage not only during Part D’s coverage gap, but also during Part D’s initial coverage and catastrophic phases, as well as providing assistance with some of Medicare Part D’s out-of-pocket expenses for EPIC members, refer to Health Plans, Medicare Part D, Description of Medicare Part D, Out-of-Pocket Expenses/Part D Cost Sharing, The Four Stages of Medicare Part D.

In 2014, the NYS budget expanded the income threshold of the EPIC program up to $75,000 for single individuals and up to $100,000 for married couples.

WHO ADMINISTERS THE PROGRAM

EPIC is part of the New York State Department of Health who contracts with Magellan Health Services, which administers the EPIC program.

FUNDING

EPIC is funded by the State of New York.

Summary of EPIC

EPIC offers a supplemental prescription coverage to low and moderate income Medicare Part D beneficiaries 65 and over to further reduce the cost of their prescription drugs. To be eligible an individual must be enrolled in a Medicare Part D plan, be 65 years of age or older, be a New York State resident, meet Medicare’s citizenship/immigration criteria, and have income below $75,000 a year, if single, and below $100,000 a year, if married. EPIC does not have any resource requirements. Applicants must complete the EPIC application and mail it to EPIC. No documentation is required, but EPIC reserves the right to request documentation, if needed.

Other Benefits under the EPIC Program

NEW YORK PRESCRIPTION SAVER

Beginning April 2009 New York State began offering a free prescription drug discount card to New Yorkers who have limited incomes who are between the ages of 50-64 or who have been certified disabled by the Social Security Administration. Known as the New York Prescription Saver benefit, it is a pharmacy discount card that can lower the cost of an eligible individual’s prescriptions by as much as 60% on generics and 30% on brand name drugs. For more information, see below, New York Prescription Saver.