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.

Good News for EPIC Members

EPIC New York State Senior Prescription Plan
P.O. Box 15018
Albany, NY 12212-5018
(800) 332-3742

August 2012

On January 1, 2013, the Elderly Pharmaceutical Insurance Coverage (EPIC) program will change back to a fee and deductible program and provide you with expanded prescription coverage! All members must be enrolled in a Medicare Part D drug plan to receive EPIC benefits. There will be no exceptions.

EPIC will provide secondary prescription coverage for EPIC and Medicare Part D covered drugs after the Part D deductible, if you have one, is met. EPIC will also cover many Medicare Part D excluded drugs (e.g. prescription vitamins and prescription cough and cold preparations).

You will be enrolled in either the EPIC Fee Plan or Deductible Plan, based on your income.

  • Fee Plan members will pay an annual fee to EPIC. An EPIC bill will be mailed out in December. Members will pay EPIC co-payments ranging from $3 - $20 for prescriptions after the Medicare Part D deductible, if you have one, is met. Those with full Extra Help from Medicare will have their EPIC fees waived.
  • Deductible Plan members must meet an out-of-pocket deductible before paying EPIC co-payments ranging from $3 - $20 for prescriptions. The amount paid toward the Medicare Part D deductible, if you have one, cannot be applied to the EPIC deductible.

EPIC will continue to pay Medicare Part D plan premiums, up to the amount of a basic plan, for all members with annual income below $23,000 if single or $29,000 if married. EPIC members with higher incomes will be responsible for paying their own Medicare Part D premium. However, their EPIC deductible will be lowered by the annual cost of a basic Medicare Part D drug plan.

If you have any questions about these changes please contact the EPIC Provider Helpline at (800) 634-1340 Monday through Friday from 8:30 AM to 5:00 PM. Call the toll-free EPIC Helpline at (800) 332-3742.