This is in addition to meeting their Medicare Part D drug plan deductible should their Part D plan have one. Please note that EPIC deductible members must first meet their EPIC deductible before they pay EPIC co-payments. For example, if the EPIC member's out-of-pocket drug cost is $100, the member will pay $20. The member will pay an EPIC co-payment ranging from $3 to $20 based on the cost of the drug. After any Medicare Part D deductible is met, if the member has one, drug costs not covered by Part D (including co-payments/co-insurance) can be submitted to EPIC for payment. When purchasing prescription drugs, the member shows both their EPIC and Medicare Part D drug plan cards at the pharmacy. EPIC also covers approved Part D-excluded drugs once a member is enrolled in a Part D drug plan.ĮPIC supplements Medicare Part D drug coverage for greater annual benefits and savings. co-payment assistance after the Medicare Part D deductible is met, if the member has one.Medicare Part D drug plan premium assistance.a Medicare one-time plan change per calendar year for existing members.a Medicare Special Enrollment Period (SEP) so that a new member may enroll in a Part D drug plan at any time during the year.
If a member is not enrolled in a Medicare Part D drug plan, the member will not have any prescription coverage from EPIC or receive any EPIC benefits.īecause EPIC is a State Pharmaceutical Assistance Program, EPIC can provide: This means that EPIC benefits are not as generous as Medicare Part D. The New York State EPIC program is not Creditable Coverage (primary coverage) for members. EPIC also covers approved Part D-excluded drugs such as prescription vitamins as well as cough and cold preparations after enrolling in a Part D drug plan.
After a Part D deductible is met, if a member has one, EPIC provides secondary coverage for approved Part D and EPIC covered drugs. Medicare Part D provides primary drug coverage for EPIC members. Enrolling in EPIC will give a member a Special Enrollment Period (SEP) to join a Medicare Part D drug plan. All Health Care Professionals & Patient SafetyĮPIC and Medicare Part D How does the Medicare Part D drug plan requirement work?ĮPIC members are required to be enrolled in a Medicare Part D drug plan or a Medicare Advantage (HMO) health plan with Part D (with no exceptions).Clinical Guidelines, Standards & Quality of Care.
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