2011-12-23 / Top Stories

Reduced Payouts From EPIC

Seniors across New York State, who have prescription drug coverage under the state’s EPIC (Elderly Pharmaceutical Insurance Coverage) program, will see their benefit and other program assistance greatly reduced starting January 1, 2012. This is the second round of changes to the program resulting from over $36 million in funding cuts in the state budget. Initial changes were implemented in July 2011.

“The reduction in EPIC coverage resulting from state budget cuts means seniors in New York State will most certainly be paying more for the medications the need,” stated Lois Wagh Aronstein, AARP New York State Director. “The average EPIC enrollee is 78 years old and takes four prescription drugs. These changes shift a major burden onto these seniors, hitting them hard in these tough economic times.”

As part of the latest round of changes, EPIC will only provide prescription drug coverage once an enrollee falls into the Medicare prescription drug coverage gap (also known as the “doughnut hole”), with an exception only for those with the lowest income.

The “doughnut hole” starts when the total drug cost reaches $2,930 for an individual.

For many enrollees the changes mean EPIC will no longer provide:

Assistance with paying co-payments for prescriptions until an enrollee reaches the Medicare Part D coverage gap;

Assistance with covering Medicare Part D premiums and deductibles;

Help for EPIC enrollees in choosing the best Medicare Part D Plan for their prescription drug needs;

Emergency coverage if a claim is denied at the pharmacy counter – an EPIC enrollee could leave the counter without his or her medication.

A set of initial changes to the EPIC program was implemented in July 2011. The majority of changes were positive for low-income populations. They included raising the Medicare Part D premium assistance income levels to $23,000 if single and $29,000 if married.

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