New York's EPIC Drug Assistance Program

By Kendra Knouff
eMedicareSupplements Senior Writer

Plan Helps New York Seniors Get Prescription Coverage

The Elderly Pharmaceutical Insurance Coverage Program (EPIC) is a plan available to New York state seniors to assist them in paying for prescription drugs by providing secondary coverage. Many seniors enrolled in EPIC save an average of 90 percent on prescription drugs. EPIC is often used in conjunction with Medicare Part D or other prescription plans to lower drug costs and assist seniors in paying the deductibles and co-payments required by other drug plans.

In order to be eligible to enroll in EPIC, you must:

  • Be a New York state resident
  • Be at least 65 years old
  • Have an income below $35,000 (single) or $50,000 (married)
  • Join a Medicare Part D Plan (with limited exceptions)
  • *If you receive Medicaid, you are only eligible if you have a Medicaid spend-down. You are not eligible if you receive full Medicaid benefits.

EPIC is combined with Medicare Part D or other prescription drug coverage to provide higher out-of-pocket savings for New York seniors. Those at an average income level must pay a low quarterly fee and participate in the EPIC Fee Plan. Through the Fee Plan, EPIC will pay the Medicare Part D premiums up to the cost of the basic prescription drug coverage plan.

Those who have a higher income must meet an annual deductible through the EPIC Deductible Plan. Through this plan, EPIC will lower the deductible for members and help them pay for their monthly Medicare Part D premiums.

Those enrolled in either the Fee Plan or the Deductible Plan (and meet their deductible) will be responsible for a co-payment at their pharmacy when they purchase prescription drugs.

In addition to use with Medicare Part D, EPIC can also be used to supplement other prescription drug coverage for higher out-of-pocket savings. Using EPIC with another prescription drug coverage plan will result in the lowest co-payment possible. For example, if someone is enrolled in both EPIC and another prescription drug coverage plan and is required to pay a $25 co-payment on a brand name drug that costs $100, the $25 co-payment will be covered by EPIC, and the member will only be required to pay the small EPIC fee, which is $7. If EPIC was not used, the member would have paid the $25 co-payment. If only EPIC was used, the member’s cost would have been $20. Combining the two plans significantly lowers the out-of-pocket costs of prescription drugs for eligible seniors.

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