Elderly Pharmaceutical Insurance Coverage (EPIC) Program
EPIC is a prescription assistance program for people 65 years of age and older living in New York State. Seniors are eligible if they have an annual income of $35,000 or less if single, or $50,000 or less if married.
If you receive full Medicaid benefits or have other prescription coverage that is better than EPIC, then you are not eligible for EPIC benefits.
To find out more about EPIC, visit www.health.state.ny.us/nysdoh/epic/faq.htm or call EPIC at 1-800-332-3742
Medicare
Medicare is a federal health care coverage program for people age 65 and older, people with certain disabilities, and people with End-Stage Renal Disease. Medicare recipients can purchase coverage for prescription drugs under one of the supplemental medical insurance plans, Medigap. For more information, visit hiicap.state.ny.us or contact the HIICAP program at Lifelong, (607) 273-1511.
For more information on the Medicare-approved drug discount cards or the Part D Prescription Drug Benefit, visit:
www.medicare.gov (Medicare) or call 1-800-633-4227. TTY users, 1-877-486-2048.
www.medicarerights.org (Medicare Rights Center) - An independent source of health care information and assistance for people with Medicare.
Extra Help with Medicare and EPIC
If you have Medicare and have limited income and resources, you may qualify for Extra Help paying for your prescription drugs. With Extra Help, you wil not pay any premium or deductible for your Medicare drug coverage. You will only pay a co-payment of $2 for generic drugs and $5 for brand-name drugs.
To qualify for Extra Help, your annual income for 2005 must be below $12, 920 if single or $17,321 if married. Resources must be no greater than $7,500 for a single person and $12,000 for married couples. Some examples of resouces are: bonds, stocks, CDs, savings accounts, IRAs, and other funds. If your income or resources are higher, you may qualify for some Extra Help in paying for any premiums, deductible, and co-payments.
EPIC will help you apply for Extra Help and help you choose a Medicare drug plan. For for information, call the EPIC hotline at (800)332-3742. They can refer you to HIICAP counselor in yor county who can work with you to help select a plan.
Prescription Discount Cards and GVHP-Rx
Prescription discount cards can be an effective way of lowering drug costs. Prescription discount cards entitle the holder to a discount off the retail price of prescription medicine at participating drug stores.
Pharmaceutical Company Patient Assistance Programs for Free and Low-Cost Medicine
Patient assistance programs are charitable programs offered by pharmaceutical manufacturers that make certain branded and generic medicine available for free or very low cost. People served by these programs typically have low incomes and no prescription drug coverage. Individual companies have their own income eligibility standards although most programs help patients whose monthly household incomes fall below 200 percent of the federal poverty level. A few companies make special exceptions for patients with high medical costs, so inquiries can be made to specific programs. Each company has its own application process.
There are websites that allow individuals to find out if his or her medication is available through a manufacturer-sponsored patient assistance program. Usually, the individual can either download an application or find a toll free phone number to obtain an application. A sample of websites are:
- www.rxassist.org - an online tool that helps healthcare providers or consumers find information on pharmaceutical company patient assistance programs for free or low cost drugs.
- www.needymeds.com - is a site designed to provide information about patient assistance programs that provide no cost prescription medications to eligible participants.
- www.PPARx.org - Partnership for Prescription Assistance, a collaboration of pharmaceutical companies, health care providers, advocacy groups, and community groups that assists patients, prescribers, and caregivers with finding out what prescription drug patient assistance programs are available. Applications can be downloaded online as well. To find out more, visit their website, or call
1-888-4PPA-NOW (1-888-477-2669).
Organizations that Help with Applying to Pharmaceutical Company Patient Assistance Programs - Since the application process can be difficult to navigate, a number of organizations can help guide a patient or caregiver through the application process starting with provision of the necessary application forms.
- www.FreeMedicineFoundation.com- a patient advocacy organization that helps coordinate the application process for a small administrative fee of $5 per prescription. Visit the website or call, 1-866-841-4680.
- www.PPARx.org - Partnership for Prescription Assistance, will help individuals apply to pharmaceutical company patient assistance programs. Call 1-888-4PPA-NOW (1-888-477-2669).
Medicaid
Medicaid is a program for New Yorkers who can't pay for medical care. People who meet certain income, resource requirements, age, or disability requirements may be eligible for enrollment. Even with a higher income, pregnant women and children, disabled persons, and those with high medical bills may qualify.
Medicaid covers many health care services such as physician visits, hospital inpatient and outpatient visits, diagnostic services, medicine, dental care, supplies and equipment, mental health treatment, ambulance, family planning, and more.
To find out more, visit www.health.state.ny.us/health_care/medicaid/index.htm or call you local department of social services to enroll.
What If You Have Health Insurance?
Sometimes people who have medical health insurance but do not have prescription coverage may be able to access a discount program through their insurer. The discount program may consist of a mail order service for health insurance members or possibly discount arrangements with select pharmacies.
For more information, contact the member services representative for your health insurance company.
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