Question: EPIC sent a letter saying it was changing, but I don’t remember what it said. Will my medications still be covered?

Answer: New York state is one of a limited number of states that provides assistance with prescription drug coverage for those who qualify, EPIC. The EPIC program (Elderly Pharmaceutical Insurance Coverage) to New York State residents, who are over age 65 and make less than $75,000 for an individual and $100,000 for a married couple. (This income standard is based on last year’s income.)

EPIC has two levels of coverage, the Fee Plan and the Deductible Plan. Most individuals/couples fall into the Deductible Plan. When you apply for EPIC, they determine your eligibility and will explain the coverage plan you have. For some lower income situations, EPIC even pays your Part D plan premium for you up to $38.90 per month. You simply fill out the application for EPIC and EPIC will inform you of your coverage situation and rules.

Earlier this year EPIC sent a letter to all enrollees explaining a change that was coming on July 1 relating to the coverage of a limited number of name brand medications. Well July 1 is now here, and those changes will be effective very soon. EPIC works with pharmaceutical companies to agree on allowable pricing and discounts, which means savings for you at the pharmacy.

As of July 1, 2023 GlaxoSmithKline has decided that it will not agree to the previously negotiated cost for the medications it manufactures. GlaxoSmithKline has withdrawn from the EPIC Manufacturers Rebate Program. Therefore, EPIC can no longer cover these medications and reduce the price you pay at the pharmacy for these brand name medications.

The medications no longer covered are the following: Advair Diskus, Advair HFA, Anoro Ellipta, Arnuity Ellipta, Avodart, Beconase AQ, Breo Ellipta, Coreg, Coreg CR, Epivir HBV, Flovent Diskus, Flovent HFA, Imitrex, Incruse Ellipta, Jalyn, Lamictal, Lamictal XR, Nucala, Serevent Diskus, Trelegy Ellipta, Valtrex, Ventolin HFA, Wellbutrin SR.

If any of these medications are medications that you take, your Part D plan will continue to cover them, but EPIC will not be able to include the costs you pay for them into your EPIC deductible or fee structured benefit.

Many of these name brand medications are available generically, so you may be taking the generic version, and in that case, your medication coverage will continue as it has been with both your Prescription Drug Plan and EPIC helping to pay the cost of the medication. It is only the name brand medications that are affected by this change. This information is very frustrating. But you can work with your doctor and pharmacy to find alternative medications that may be an appropriate substitution. You should NOT stop taking your medications.

I am also concerned that other pharmaceutical companies will follow suit and stop negotiating their pricing structure with EPIC. We have a significant number of individuals over 65 in New York, and of those over 325,000 are enrolled in EPIC. That is a lot of people. But when you think of how many individuals across the country are enrolled in Medicare and therefore Part D coverage the number jumps to over 65 Million. So our 325,000 enrolled in EPIC is a very small number for those pharmaceutical companies to worry about not using their particular medications.

Please work with your pharmacy and physician if this list of medications includes something you take personally. As I said earlier, some of the medications on this list are available in generic form, so you could substitute a generic version and your Part D and EPIC will continue to help pay the cost of the medications. You can research to see if there are alternative medications available to you. In finding an alternative medication to take, your Part D plan and EPIC will continue to save your money AND GlaxoSmithKline doesn’t get the sale of their pharmaceutical medication.

EPIC can be reached at 1-800-332-3742 during normal business hours. You can get EPIC applications at most pharmacies in New York State. You can also download an application from the website; www.health.ny.gov/health–care/epic/

EPIC has been around since 1985 and has helped New York State Seniors save a significant amount of money all of those 38 years. You have made a smart decision to enroll in Medicare Part D and EPIC. Be sure to show both insurance cards to your pharmacists. Neither insurance products save you money if the pharmacy doesn’t know you have them.

Janell Sluga is a Geriatric Care Manager helping seniors in our community access services and insurance. To reach her, please email editorial@post-journal.com.