Provider Bulletin 08-02 August 2008
EPIC New York State Senior Prescription PlanP.O. Box 15018
Albany, NY 12212-5018
1-800-332-3742
EPIC Bulletin No. 08-02
August 2008
EPIC Participant NameAddress 1
Address 2
City, State, Zip
Dear EPIC Member:
We want to let you know about some improvements we are making at EPIC starting October 1, 2008. These changes will help EPIC make sure you continue to receive the drugs you need at the lowest possible cost.
Generics offer an excellent opportunity to pay less for the same drug. In fact, most EPIC enrollees are already using generic drugs when they are available. They have the same active ingredients as the brand name drug, so they work the same as the brand. Therefore, unless the brand drug is being covered by a senior's Medicare Part D or other drug plan, EPIC will require that new prescriptions for a brand name drug that has a generic available be filled with the generic drug. EPIC will cover the brand name drug, but only if the doctor calls and informs us the brand is medically necessary. Because generics are less expensive, the EPIC co-payment will often be lower.
We also want you to know that if you have Medicare Part D or other drug coverage that does not cover a drug you need, it will still be covered by EPIC. Your pharmacist will check with your doctor first to see if another drug covered by your primary plan can be used instead. If your doctor cannot be reached or decides not to change the prescription, after paying for your drug, EPIC may send a request to your primary plan to cover the drug. The plan will let you know what they decide. If they approve the request, they will cover your next prescription along with EPIC, which may lower your co-payment. If they deny the request, EPIC will continue to cover the drug. If you have any questions, please call your plan or the EPIC Helpline at 1-800-332-3742.
This information is also being provided to your pharmacy. Please be assured that your doctor will continue to be the person who decides which drugs you should take, and that EPIC will continue to help you pay for them.
Sincerely,
Julie Naglieri
Director
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