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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.
To be eligible for this program, seniors must meet the following criteria:
The EPIC program will pay for Medicare Part D premiums. As of 2018, a maximum of $39 per month is made available for Part D premiums for single seniors with income up to $23,000 or married couples with income up to $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.