Important Notice: Attention Supervising Pharmacist
Beginning on January 1, 2012, the Elderly Pharmaceutical Insurance Coverage (EPIC) program will change. EPIC will only cover Part D covered drugs purchased while in the Medicare coverage gap (donut hole). However, EPIC will also cover Medicare Part D "excluded drugs", such as benzodiazepines and barbiturates, while in the coverage gap. EPIC assistance will only be available when the member is in the coverage gap. During this period, EPIC co-payments will be $3-$20 depending on the cost of the drug. Before reaching the coverage gap, members will need to pay the price charged by their Part D plan.
In addition to this change, the Temporary Coverage Request (TCR) process where EPIC grants temporary supplies of medication while the prescriber pursues the Part D appeal process will end on December 31, 2011. Extended coverage by EPIC of any drugs that were denied by the Part D plan after two levels of appeal will also end on December 31, 2011. The member will have to pay for the medication. If applicable, please discuss alternative drug therapy with the member that will be covered by their Part D plan in 2012.
EPIC will be sending a letter to members explaining these changes to the program along with a letter explaining that EPIC is no longer creditable coverage (attachments). If you have customers who have questions about how these changes will affect them, please have them contact the EPIC Participant Helpline at 1-800-332-3742 for more information regarding their coverage.
If you have any questions or require further assistance please contact the EPIC Provider Helpline at 1-800-634-1340.