Important Notice: Attention Prescribers

August 2012

Effective January 1, 2013, many Elderly Pharmaceutical Insurance Coverage (EPIC) program benefits will be restored. This notice provides information about these changes and how they may affect your patients.

  • EPIC eligibility remains the same. You must:
    • be a resident of New York State
    • 65 or older
    • have annual income up to $35,000 if single or $50,000 if married, and
    • may have a Medicaid Spend down but not receiving full Medicaid benefits.
  • EPIC members must be enrolled in a Medicare Part D plan in order to receive EPIC benefits.
  • EPIC will reinstate its Fee and Deductible Plans.
  • EPIC will provide secondary coverage for EPIC and Medicare Part D covered drugs after any Part D and/or EPIC deductible is met.
  • EPIC co-payments for covered drugs will continue to be $3 - $20, depending on the cost of the drug.
  • EPIC will continue to cover many Medicare Part D excluded drugs, such as prescription vitamins and prescription cough and cold preparations.
  • EPIC will continue to pay Medicare Part D premiums, up to the amount of a basic plan, for members in the Fee and Deductible plans with income up to $23,000 (single) or $29,000 (married).
  • EPIC will also lower the EPIC deductible, by the annual cost of a basic Medicare Part D drug plan, for members with higher incomes that are responsible for paying their own Medicare Part D premium.

If your patients are currently receiving drugs that are not on their Part D formularies, please discuss alternative drug therapies that will be covered by their Part D plans in 2013. Prescribing drugs on the Medicare Part D formulary will maximize coverage and reduce your patients' out of pocket expenses.

EPIC has included a copy of the letter sent to members explaining these program changes. If you have patients who have questions about how these changes will affect them, please have them contact the EPIC Participant Helpline at (800) 332-3742.

If you have any questions or require further assistance please contact the EPIC Provider Helpline at (800) 634-1340.