EPIC + - Helping Seniors Save On Prescription Drug Costs
*Average savings of 80% annually on medications
* Reduces co-pays and deductibles
* Increases income levels to include middle class
WHAT IS EPIC?
EPIC is a program that helps New York senior citizens pay for their prescriptions. Since it was created in 1986, senior citizens have saved more than $1.5 billion in prescription costs.
HAS THE PROGRAM CHANGED RECENTLY?
Yes. To help senior citizens cope with the rising cost of prescriptions, I helped enact changes so that even more seniors qualify for prescription drug assistance. The lower fees and co-payments, along with higher income limits, allowed more seniors to qualify for EPIC. Enrollment has reached close to 340,000 seniors, a 200% increase since 1994.
WHO CAN JOIN?
New York State residents aged 65 or older who have little or no prescription drug coverage through a private insurer or Medicaid can qualify if their incomes are below the new limits.
WHERE CAN I GET AN APPLICATION?
Applications are available at pharmacies, doctors' offices, senior centers and local county offices for the aging. Seniors can also call EPIC's Helpline at 1-800-332-3742 to request an application, or visit the NYS Department of Health web site at: www.health.state.ny.us.
HOW DOES EPIC WORK?
Once enrolled, a senior citizen will receive an official EPIC card. Simply show the card to your pharmacist and start saving. You will have a small co-payment for each prescription, and depending on your income, an annual fee or a deductible.
There is an annual limit on the amount of co-payments that seniors pay, based on income. After reaching the limit, seniors receive their prescriptions free for the remainder of the year.
HOW MUCH DOES EPIC COST?
Depending upon annual income, seniors are enrolled in either the fee plan or the deductible plan. Under EPIC+, all single seniors with incomes below $20,000, and all married seniors with incomes below $26,000, will go into the fee plan. Seniors with higher incomes, up to $35,000 for singles and $50,000 for married couples, will enroll in the deductible plan. Under both plans, co-payments for specific drugs are based on the list price of the prescriptions you need, and range between $3 and $20.
WHAT DRUGS ARE COVERED?
Almost all prescription medicines are covered, as well as insulin, insulin syringes and needles. Both brand name and less expensive generic drugs are included. Enrollees can buy up to 100 tablets, or a 30-day supply, at a time, saving you extra trips to the pharmacy. EPIC also protects the health and safety of seniors by sending electronic alerts to pharmacists if there is a potentially serious drug interaction or overuse problem. These alerts are helpful when seniors go to more than one physician or pharmacy and the doctor/pharmicist is unaware of all the prescriptions the senior may be using.
FEDERAL MEDICARE PRESCRIPTION DRUG, IMPROVEMENT AND MODERNIZATION ACT OF 2003
The Medicare Prescription Drug, Improvement and Modernization Act of 2003 creates a voluntary, federally subsidized outpatient prescription drug benefit under the Medicare program, with additional federal subsidies for drug coverage offered to certain lowincome Medicare beneficiaries. In April 2004, the federal Centers for Medicare and Medicaid Services announced that state pharmacy assistance programs,like EPIC, could auto-enroll low-income beneficiaries into a Medicare-approved drug discount card program. New York State followed suit, enacting legislation that authorized implementation of the federal program for EPIC enrollees. In conjunction with the discount card, seniors with incomes below 135% of the federal poverty level are eligible for a $600 prescription drug subsidy from the federal government. The program does not affect EPIC eligibility or benefits. Subsequent federal rules allowed New York State to enroll qualified EPIC beneficiaries automatically into a drug discount card program. However, states must provide seniors with an opportunity to "opt-out" of the program if they choose not to participate. In New York State, seniors can do so by calling the EPIC hotline at 1-800-332-3742. Participation in the discount card program began on June 1, 2004, and the actual Medicare prescription drug benefit will go into effect in January 2006.
HOW CAN I FIND OUT MORE ABOUT EPIC?
You can get information on how to apply for EPIC by calling the toll-free EPIC Helpline between 8:30 a.m. and 5:00 p.m., Monday through Friday.
The Helpline number is 1-800-332-3742. To visit the State Health Department's web site and see the new fees, new deductibles and to get an EPIC application,