Implemented in 1987, the Elderly Pharmaceutical Insurance Coverage Program (EPIC) provides affordable pharmaceutical insurance coverage to New York State’s seniors. The Program promotes the health and safety of EPIC seniors by helping them purchase medications that improve their quality of life and keep them healthy. The program includes a prospective prescription claim-review system that sends electronic clinical alerts to pharmacists, warning them of any potential serious drug interactions prior to dispensing the medication. EPIC also performs retrospective reviews of the medication history of enrollees to identify any dangerous or aberrant medication problems.
EPIC is available to New York residents aged 65 years or older whose incomes are under $35,000 for singles and $50,000 for couples. Enrollees cannot currently be receiving Medicaid benefits or have other prescription coverage that is better than EPIC. Effective July 1, 2007, all EPIC participants are required to join a Medicare Part D drug plan as a condition of continued participation in EPIC, unless such enrollment would result in significant additional financial liability on behalf of the participant. EPIC will facilitate the enrollment of seniors into Part D benchmark plans, based on their drug and pharmacy needs. Seniors will be given the opportunity to choose their own plans, if desired. EPIC will facilitate enrollment of Medicare Advantage members into a Part D plan, to the extent an appropriate option is available and under the benchmark premium. EPIC will provide wrap-around coverage for drug costs not covered by the Medicare drug plan. Seniors will save more on their prescription drugs by using EPIC and Medicare together. For State Fiscal Year (SFY) 2007-2008, EPIC is funded at over $807 million.
Director of the New York State Office for the Aging (NYSOFA) serves as co-chair of the EPIC Panel with the Commissioner of the State Department of Health (DOH) and shares responsibility for the administrative oversight of the program.
