Question: I just received a letter from EPIC which states some of my medications will no longer be covered by EPIC. What is happening?

Answer: New York State is one of a limited number of states that provides extra Prescription Drug Coverage for those who qualify. New York State’s EPIC program (Elderly Pharmaceutical Insurance Coverage) is available to any resident of New York State (must live in NY state), be 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. Most individuals/couples fall into the Deductible Plan that keeps track of your medication expenses at the pharmacy. When you reach your deductible, EPIC begins to save you more money on your prescription drugs. Once your EPIC deductible has been met using your Part D plan co-pays, your medications will cost less money because EPIC pays part of the copays.

For those individuals/couples with the EPIC Fee Plan you pay a Quarterly or Annual Fee for enrollment in EPIC, in return EPIC helps to pay for your medications immediately. The amount you pay EPIC is a sliding scale depending on your income. If you are in the EPIC Fee plan, EPIC also helps you to pay your Medicare Part D monthly premium.

This may sound complicated, but it really isn’t. You simply fill out the application for EPIC and EPIC will determine and inform you of your coverage situation and rules.

The letter you recently received relates to some of the changes we are seeing with regard to drug pricing. In order for EPIC to work, the pharmaceutical company must agree to the price for that medication. In this situation, GlaxoSmithKline has decided that it will not agree to the previously negotiated cost for the medications it manufactures. Therefore EPIC can no longer cover these medications. Many of these medications are related to your breathing or pulmonary conditions, but not all of them are.

So if any of those 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.

This information is very frustrating. I believe it is becoming harder to determine what medications are covered and how much they will cost with your Part D plan. Now you also have to factor in the fact that EPIC may not cover some of the medications you take.

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.

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 also speak with your physician 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.

Wait for your copy of this EPIC notification. 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.

Senior Life Matters is a community based program sponsored by Lutheran Jamestown. For questions and concerns or to reach Janell Sluga, GCMC, call 716-720-9797 or email at SLM@lutheran-jamestown.org.