EPIC – NY state residents only

​EPIC (Elderly Pharmaceutical Insurance Coverage) is the New York State Pharmaceutical Assistance Program (SPAP) that helps older adults with Medicare pay for prescription drug costs. EPIC is available to New York State residents who:

• Are 65 years or older
• Have annual incomes below $75,000 if single or $100,000 if married
• Do not receive full Medicaid benefits
• And are enrolled, or eligible to be enrolled, in a Medicare Part D drug plan or
• Medicare Advantage Plan that provides drug coverage

Your EPIC benefits are determined by whether you are eligible for the Fee plan or
Deductible plan:

EPIC Fee plan

• To qualify for the EPIC Fee plan, your income must be less than $20,000/year  if single or less than $26,000/year if married.

EPIC Deductible plan
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• To qualify for the EPIC Deductible plan, your income must range from  $20,001-$75,000/year if single and $26,001-$100,000/year if married.

Remember, EPIC works with your Part D plan to help you pay for your prescription drugs. You must have a Part D plan to have EPIC. EPIC will act as secondary (supplementary) coverage for EPIC- and Part D-covered drugs, after your Part D and/or EPIC deductible is met. Your Part D plan must pay first on your drugs, and EPIC will pay second. EPIC may also cover medications that Medicare Part D doesn’t cover (excluded drugs), such as prescription vitamins and minerals.

If you have EPIC, you have a once-per-year Special Enrollment Period (SEP) to switch your Part D or Medicare Advantage coverage. If you have additional questions about EPIC, contact the toll-free EPIC helpline at 800-332-3742.