Elderly Pharmaceutical Insurance Coverage (EPIC) Program
EPIC is a NYS senior prescription plan that provides supplementary drug coverage for those enrolled in Medicare Part D drug plans. EPIC provides secondary coverage for drugs covered by a member's Medicare D plan, after any Part D deductible, if they have one, is met. EPIC also covers many Part D excluded drugs. Seniors must purchase their prescriptions at a NYS pharmacy participating in EPIC. Almost all community pharmacies in NYS, as well as several mail order pharmacies in the state, participate in EPIC. Seniors can call the toll-free help line to inquire if their pharmacy is participating in EPIC.
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211 Western New York
Physical Address
New York State Department of Health, Albany, NY 12237
Hours
Thursday 8:00 AM - 5:00 PM Friday 8:00 AM - 5:00 PM Monday 8:00 AM - 5:00 PM Tuesday 8:00 AM - 5:00 PM Wednesday 8:00 AM - 5:00 PM
Fax
(518) 452-3576
Fax
Application process
Call the toll free help line listed above. The help line will answer questions, send out applications and other information, and resolve any problems seniors may have with the EPIC program. Seniors should complete an application and report their gross annual income, excluding Social Security Part B payments for the calendar year preceding the date of the application. Married couples, by law, must provide joint annual income even if only one spouse is applying for EPIC.
Fee
EPIC co-pays will continue to range from $3 - $20, based on the out of pocket cost of the drug once Medicare Part D is billed. EPIC will pay the Medicare Part D drug plan premium up to the basic amount up to $48.72 per month in 2024 for those with income up to $23,000 single and $29,000 married. Those with higher income are responsible to pay the Part D plan premiums each month. They will receive Part D premium assistance by having a lower EPIC out-of-pocket deductible.
Eligibility
Seniors may join if they are 65 or older, live in NYS, have an annual income up to $75,000 if single and up to $100,000 if married, and are not receiving full Medicaid benefits. A member must be enrolled in a Medicare Part D drug plan to receive EPIC benefits. Applicants can apply and enroll in EPIC at any time of the year and they will receive a Special Enrollment Period to join a Part D drug plan if they are not already enrolled. Service Area: NYS.
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Service area
Wyoming County, NY Genesee County, NY Erie County, NY Chautauqua County, NY Cattaraugus County, NY Orleans County, NY Niagara County, NY
Agency info
New York State - Health Department