Combining Prescription Coverage to Save Money

Seniors: Sign up now for Medicare Part D and NY’s EPIC program
December 1, 2006

My office continues to receive a number of calls from seniors looking for ways to offset the cost of prescription drugs. In many cases, seniors are constrained by a tight, fixed budget but can find some relief by using New York State’s Elderly Pharmaceutical Insurance Coverage (EPIC) program with Medicare Part D coverage.

Medicare Part D is a federal program that provides prescription drug benefits to senior citizens to help defray the costs of necessary medicines. Enrollment for the program is open through December 31. Seniors not already enrolled in the program are encouraged to look into joining now. If already a recipient but changing current coverage, program administrators encourage you to do so by December 8 to ensure you can get the prescriptions you need beginning January 1, 2007.

There are many Medicare Part D plans to choose from, each with varying amounts of coverage and its own list of approved medications, also known as a formulary. Be sure to review the program carefully and choose the one that works best for you.

You may want to consider furthering your prescription drug coverage by supplementing it with New York state’s EPIC program. EPIC does not have a formulary and will cover most drugs that a Medicare Part D plan does not cover. In addition, EPIC can help lower co-payments for prescription drugs under the Medicare Part D program.

Seniors with an income of $35,000 or less for singles or $50,000 or less for couples are eligible for EPIC. The EPIC program has two tiers: one tier for lower income people who pay an annual fee based on their income plus a co-payment based on the cost of the drug and another tier for higher income people who pay an annual deductible and, once the cost of their drugs meets their deductible, they also pay a co-payment based on the cost of the drug. Already the program has over 360,000 subscribing members who are saving, on average, over 80% of the cost of their medicines.

EPIC participants pay their annual fee or deductible, and then pay only a co-payment for each prescription. Nearly all prescription drugs are covered, both brand name and generic. Seniors who receive full Medicaid benefits are not eligible for EPIC benefits. However, those with other prescription coverage through Medicare Part D or most other plans can join EPIC to cover drug costs their other coverage does not include. With the additional coverage of EPIC, the enrollee simply shows both coverage cards at the pharmacy and often times the co-payment will be lower than using only EPIC or the other coverage alone.

I strongly recommend those who qualify use EPIC and Medicare Part D together to receive the prescription drugs needed at the lowest co-payment possible. If you or someone you know can use more information about combining EPIC and Medicare Part D, you can call the EPIC toll free hotline at 1-800-332-3742.