What's New?

2013 Program Changes

The 2013 EPIC program changes flyer is available. The document includes the 2013 EPIC Fee Plan and Deductible Plan schedules.

Attention Members, Prescribers and Pharmacists - July 2012

There were articles in the July 2012 Medicaid Update for EPIC members, prescribers and pharmacy providers giving information regarding the upcoming 2013 program changes to EPIC coverage.

SFY 2012-2013 Key Points and Additional FAQs

Beginning January 1, 2013, Executive Budget Changes have restored the EPIC program with additional provisions. The frequently asked questions are listed in SFY 2012-2013 Key Points and Additional FAQs.

EPIC Deductible Plan

The Deductible Plan is for members with income ranging from $20,0001 to $35,000 if single or $26,001 to $50,000 if married. Members must meet an annual EPIC deductible based on their prior year's income before they pay EPIC co-payments for drugs (see Deductible Plan schedule). An EPIC identification card is mailed to the member upon successful enrollment. This card is issued once and should be kept and used for subsequent years. The coverage year runs through December 31st each year.

EPIC pays the Medicare Part D drug plan premiums up to $43.22 in 2013 for members in the Deductible Plan with incomes ranging from $20,001 to $23,000 if single or $26,001 to $29,000 if married.

Deductible Plan members with income between $23,001 to $35,000 if single or $29,001 to $50,000 if married are required to pay their Medicare Part D plan premium each month. To provide Part D premium assistance, the EPIC deductible shown on the Deductible Plan schedule is further reduced by $519 per year, the annual cost of a basic benchmark Part D drug plan.

This is how EPIC works for Deductible Plan members:

  • Show both your Medicare Part D drug plan and EPIC ID cards when you go to the pharmacy to purchase your drugs.
  • Your Part D drug plan is your primary drug coverage and you must maintain enrollment in a Part D drug plan in order to receive EPIC benefits.
  • EPIC provides secondary coverage for Medicare Part D- and EPIC-covered drugs after you meet your Medicare Part D deductible if you have one.
  • Once enrolled in a Part D drug plan, EPIC also covers approved Part D-excluded drugs such as prescription vitamins and prescription cough and cold preparations.
  • After you meet any Part D deductible if you have one, out-of-pocket drug costs for covered Part D and EPIC medications will be applied to your EPIC deductible.
  • Once you are enrolled in a Part D drug plan, drug costs for approved Part D-excluded drugs will be applied to your EPIC deductible.
  • After you meet your EPIC deductible, you will only pay the EPIC co-payments ranging from $3 to $20 based on the cost of your drug.