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New York State EPIC Program. January 2012 Changes. Overview. The 2012 program changes complete the transition of the NYS EPIC program to a supplemental drug benefit program Part D coverage is maximized

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New york state epic program

New York State EPICProgram

January 2012 Changes


The 2012 program changes complete the transition of the NYS EPIC program to a supplemental drug benefit program

  • Part D coverage is maximized

  • Seniors maintain access to needed medications during the Part D coverage gap when out-of-pocket drug costs are the highest

  • EPIC continues to provides Part D premium assistance for members with low to moderate incomes


To join EPIC, a senior must:

- be a NYS resident 65 years of age or older

- have annual income below $35,000 Single or $50,000 Married

- not be receiving full Medicaid benefits

- be enrolled or eligible to enroll in a Medicare Part D drug plan (no exceptions)

Summary of changes
Summary of Changes

Major changes to EPIC will take place January 1, 2012

  • EPIC will be a free program

  • EPIC Fee and Deductible plans will be eliminated

  • Members are required to enroll in a Part D drug plan and maintain coverage to receive EPIC benefits

  • EPIC will provide supplemental prescription coverage only while in the Part D coverage gap:

    - Co-payments will range from $3 - $20

    - Covers Part D approved drugs purchased in the coverage gap

    - Covers drugs in Part D excluded drug classes

    e.g. anti-anxiety (benzodiazepines) and anti-seizure (barbiturates)

    purchased in the coverage gap


  • EPIC will pay the Medicare Part D premiums for members with income up to $23,000 or less Single or $29,000 or less Married

  • EPIC will pay up to the basic benchmark (average cost) of a Medicare Part D plan in New York State, $39.79 per month in 2012

    If income is above these levels, member will be responsible to pay the Medicare Part D premium each month

  • EPIC will continue to help members apply for the Medicare Low Income Subsidy (LIS) Extra Help and Medicare Saving Programs (MSP) to save more. Those approved will pay the Medicare co-payment for drugs

  • EPIC will continue to pay Part D premiums for partial LIS members and those with full LIS in enhanced plans

Special enrollment period
Special Enrollment Period

EPIC members receive a Special Enrollment Period (SEP) that enables them to join Medicare Part D or make a change in their Part D drug coverage outside of the Annual Enrollment Period

  • New EPIC members can use the SEP to enroll in a Medicare Part D drug plan

  • All EPIC members can use the SEP to change their Part D plan once during the year

Tcr and extended overrides
TCR and Extended Overrides

The EPIC Temporary Coverage Request (TCR) Helpline will end on December 31, 2011

- Members can receive up to a 90-day temporary supply of medication until December 31, 2011 if their doctor calls the TCR Helpline and attests that an appeal will be filed with the Part D plan

- Members with extended overrides for drugs denied by the Part D plan appeal process will be notified that EPIC will not cover the drug after December 31, 2011


  • Letters to all 292,000 members were sent mid August notifying them of the program changes and that EPIC will not be creditable coverage (primary) in 2012

  • Notices to EPIC pharmacy providers and prescribers were sent by email

  • Program changes were communicated to advocates and partners


  • Letters were sent to members in Medicare Advantage plans without Part D, encouraging them to contact their plan to enroll in a Part D option for 2012

  • Letters were sent to members that do not have a Medicare number on file, requesting them to provide the number to EPIC to help them enroll in drug coverage for 2012

    - Letters will be sent to members with union/retiree benefits encouraging them to contact their plan to learn about their drug coverage benefits for 2012

  • The EPIC website is being updated for the new program

    - A new EPIC brochure and application will be available in late fall

Information and assistance
Information and Assistance

EPIC Program

Participant Helpline: 1-800-332-3742

(TTY 1-800-290-9138)

Provider Helpline or Temporary Coverage Request (TCR) Line: 1-800-634-1340

Web:, click on EPIC for Seniors

What is new york prescription saver nyps
What is New York Prescription Saver (NYPS)?

A free pharmacy discount card that lowers prescription costs by as much as:

- 67% on generic drugs

- 24% on brand name drugs

Ways to apply:

- Online at

- Print an application from the website, complete it and mail

- By phone at 1-800-788-6917

Who can join
Who Can Join?

- NYS residents who do not receive Medicaid

- Age 50 up to 64 or

- Persons with a disability and determined disabled by Social Security Administration (SSA)

- Have an annual income under $35,000 (single) or $50,000 (married) based on prior year’s income

Information assistance
Information & Assistance


Participant Helpline: 1-800-788-6917

(TTY 1-800-290-9138)

Provider Helpline: 1-800-785-4922

Fax Number: 1-800-774-7493

Address: NYPS

P.O. Box 12069

Albany, NY 12212-2069


Ny bridge program
NY Bridge Program

  • New York’s insurance plan for those with pre-existing medical conditions

  • No deductibles

  • Preventive care

  • Low co-pays

  • Pharmacy benefits

  • Vision care

  • Visit