Important Notice: Attention Prescriber
August 2011
Beginning on January 1, 2012, the Elderly Pharmaceutical Insurance Coverage (EPIC) program will change. EPIC will only be available to those who have Medicare Part D as their primary insurance. EPIC will no longer provide primary drug coverage for members. This may result in your EPIC patients having reduced access to some medications and larger out-of-pocket expenditures.
EPIC will only cover Part D covered drugs purchased while in the Medicare coverage gap (donut hole). However, EPIC will also cover Medicare Part D "excluded drugs", such as benzodiazepines and barbiturates, while in the coverage gap. During this period, EPIC co-payments will be $3 - $20, depending on the cost of the drug. Before reaching the coverage gap, members will need to pay the price charged by their Part D plan.
Currently, EPIC members can receive up to a 90-day temporary supply of a medication that is not covered by Part D. The prescriber must contact the EPIC Temporary Coverage Request (TCR) Helpline at 1-800-634-1340 and pursue the Part D appeal process. This Helpline will be operational only until December 31, 2011. Extended coverage by EPIC of any drugs that were denied by the Part D plan after two levels of appeal will also end on December 31, 2011. Beginning January 1, 2012, the member will have to pay for this medication. If applicable, please discuss alternative drug therapy with your patient that will be covered by their Part D plan in 2012.
EPIC is sending letters to members explaining these program changes along with a letter explaining that EPIC is no longer creditable coverage (attachments). If you have patients who have questions about how these changes will affect them, please have them contact the EPIC Participant Helpline at 1-800-332-3742 for more information regarding their coverage.
If you have any questions or require further assistance please contact the EPIC Provider Helpline at 1-800-634-1340.
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