EPIC Drug Coverage
Coverage Period
While a member is in the Medicare Part D coverage gap, EPIC provides supplemental coverage for Medicare Part D covered drugs and Part D excluded drugs such as benzodiazepines (anti-anxiety) or barbiturates (anti-seizure) drugs. Your EPIC coverage ordinarily runs from January 1st to December 31st of each year you are enrolled. If you enroll after January 1st, your coverage will still end on December 31st.
You must maintain EPIC coverage and be enrolled in a Medicare Part D drug plan in order to receive benefits. If you disenroll from your Medicare Part D drug plan either by request or due to failure to pay, you must re-enroll in a Medicard Part D plan or you will not receive EPIC benefits for the remainder of the year.
How to use EPIC:
- Show both your Medicare Part D drug plan and EPIC cards to your pharmacist. Tell your pharmacist that you have prescription coverage through both plans.
- Tell your pharmacist that your Medicare Part D drug plan is your primary prescription coverage, and all claims for prescription medications must be submitted to Medicare Part D first and then to EPIC.
- While you are in the Medicare Part D drug coverage gap, EPIC will cover Medicare Part D covered drugs and Medicare Part D excluded drugs.
What Is Covered By EPIC
For Part D covered drugs and Part D excluded drugs purchased in the Medicare Part D coverage gap:
- New prescriptions and refills;
- Insulin, insulin syringes and needles;
- Brand name and generic prescription drugs;
- Quantities up to your Part D plan's limits.
What Is Not Covered By EPIC
- Any purchases made outside the Medicare Part D coverage gap or before enrollment in EPIC;
- Drugs that are neither Part D covered drugs nor Part D excluded drugs;
- Medicines that do not require a prescription (such as aspirin or vitamins);
- A small number of drugs, known as DESI drugs (ask your pharmacist for more information on these particular drugs);
- The purchase of medical devices (for example: diabetes supplies, test strips, glucometers, walkers, wheel chairs), medical supplies (cotton balls, band aids, eyeglasses and oxygen) NOTE: Check with your Medicare carrier to see if any of these items are covered by your Medicare benefits;
- Prescriptions purchased, while in the coverage gap, at a pharmacy not participating in EPIC or located outside of New York State. (Please refer to Out-of-State Travel below).
Participating Pharmacies
You must use a participating pharmacy in New York State to receive EPIC benefits. You should choose a pharmacy that participates in both EPIC and your Medicare Part D drug plan to maximize benefits. Check with your local pharmacy to be sure they are participating before making your purchase.
Mail-Order Pharmacies
Medications may be purchased from an EPIC participating mail-order pharmacy located in New York State or an approved Medicare Part D drug plan mail order pharmacy. Check with the mail-order pharmacy for any special requirements. The Helpline can answer any questions you have or provide you with a list of EPIC participating mail-order pharmacies.
Out-of-State Travel
When traveling outside of New York State, you should make sure to bring ample supplies of all medications you will need with you. You should contact your Part D drug plan before you leave to find out their policy on refilling prescriptions while you are out of the state. Please note that EPIC only pays for Part D covered drugs and Part D excluded drugs while in the coverage gap from an EPIC participating pharmacy.
Keeping Track of Your Drug Costs
It will be helpful to you to know if you are in or are approaching the Medicare Part D drug coverage gap. You should keep your receipts and a running total of your purchases. You will need to contact your Medicare Part D drug plan to ensure they have knowledge of all your purchases and to tell you where you stand with regards to the coverage gap.
Renewing Your EPIC Coverage
Every two years, we will request that you provide EPIC updated enrollment information to renew your coverage. You may be required to provide updated income documentation to EPIC.
