Assembly Budget Restores Prescription Drug Aid for Seniors

Governor’s proposed cuts would hurt elderly New Yorkers

March 31, 2010

Albany – Assemblymember Kevin Cahill (D-Ulster, Dutchess) announced that the Assembly’s 2010-2011 budget plan protects prescription drug aid for seniors through the State’s Elderly Pharmaceutical Insurance Coverage (EPIC) program. Governor Paterson proposed eliminating EPIC coverage for drugs not covered under the Federal Medicare Part D Program when a consumer enters the so-called “donut hole”.

“More than a quarter million EPIC enrollees are saving an average of 90 percent of the cost of their medicines. The State’s efforts to step in and fill the gap in Medicare coverage has been critical for seniors struggling to find ways to continue to afford their drugs,” said Assemblymember Cahill. “No one should have to choose between medicine and other necessities like food and housing. That is what would have happened to too many elderly New Yorkers under the Governor’s plan.”

Many enrollees use EPIC to help lower their drug costs during the “donut hole” which ranges between initial coverage up to $2,700 and catastrophic coverage which starts at $6,154. The Executive Budget called for saving $32.4 million by eliminating EPIC wrap-around coverage.

The Assembly alternative would require that a doctor pursue an appeal with the Part D plan before EPIC will cover the drug. During the appeal the patient will receive an emergency supply of the prescription. If the Part D plan still rejects the claim after the appeal, EPIC will pay for the drug. A more aggressive use of the appeals process is expected to save the program $29.2 million dollars.

“New York needs to do more with less and that requires creative thinking and new approaches to funding important initiatives,” Assemblymember Cahill said. “Gutting programs without first exploring creative ways to protect them is ill advised and I am glad we were able to help seniors make ends meet by protecting EPIC.”

Assemblymember Cahill noted that the Assembly plan would also save New York $17 million by increasing the eligibility for Medicare savings programs from 135% to 185% of the federal poverty level. This would make more EPIC participants eligible for a federal subsidy of Medicare Part D premiums, tapping an unused source of federal funds.

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