EPIC Program - New York Elderly Pharmaceutical Insurance Coverage

Program Description

The New York State pharmaceutical assistance program is called Elderly Pharmaceutical Insurance Coverage or EPIC for short. This program provides financial assistance to seniors to help with the costs of prescription medications (both generic and brand names).

The program has two tiers; the Fee Plan and the Deductible Plan. Placement into one of these tiers is based on income. Both of these plans are Medicare wraparound programs, which means the benefits wrap around those benefits provided by a Medicare Part D plan, which is Medicare’s prescription drug plan. Therefore, to participate in EPIC, one must have Medicare Part D. When making a prescription purchase, Medicare Part D is the first payer and then this program contributes towards those costs the Part D plan does not cover.

There is an annual fee that ranges between $8 and $300 and is based on income for the Fee Plan. There is no charge to participate in the Deductible Plan.

This program is overseen by the New York Department of Health.

Eligibility Guidelines

To be eligible for this program, seniors must meet the following criteria:

• Be a New York resident
• Be 65+ years old
• Not be enrolled in Medicaid (also called NY Managed Long Term Care)
• Enrolled in or be eligible for a Medicare Part D plan
• Be under the annual income limit. As of 2020, the income limits are the same as the previous two years. The Fee Plan requires an annual income for single applicants of less than $20,000 or $26,000 for married couples ($1,666 / month and $2,166 / month, respectively)
• The Deductible Plan is for single seniors with income between $20,001 and $75,000 or between $26,001 and $100,000 for married couples. In monthly terms, single applicants can have income greater than $1,666, but less than $6,250, and married couples can have income greater than $2,166, but less than $8,333.

Benefits and Services

The EPIC program will pay for Medicare Part D premiums. As of 2020, a maximum of $36.55 per month is made available for Part D premiums for single seniors with income between $20,001 and $23,000 or married couples with income between $26,001 and $29,000.

EPIC also pays for prescription co-payments, coverage gap / donut hole, and some drugs not covered by Part D, such as prescription vitamins and cold and cough preparations. Fee Plan members are immediately eligible for assistance and Deductible Plan members are eligible after they’ve met a sliding scale deductible. Deductibles may be as low as $530 / year and as high as $3,215 / year. The amount is determined by one’s income.

Co-payments for prescriptions are between $3 and $20 and are based on the cost of the medication. For instance, if a medication costs $15, the co-payment is $3, and if a medication is over $55, the co-payment is $20.

How to Apply / Learn More

To learn more about this program, visit the EPIC program webpage or call their toll free number at (800) 332-3742.  This program is available statewide.  To apply one can download an application here.