New York State EPIC Program January 2012 Changes

Overview The 2012 program changes complete the transition of the NYS EPIC program to a supplemental drug benefit program – Part D coverage is maximized – Seniors maintain access to needed medications during the Part D coverage gap when out-of-pocket drug costs are the highest – EPIC continues to provides Part D premium assistance for members with low to moderate incomes

EPIC Benefit Comparison BenefitsBefore Program Changes New Program Effective 7/1/11 & 1/1/12 Income Limits$35,000 Single $50,000 Married EPIC Fee$8 - $300None EPIC Deductible$530 - $1,715None EPIC Copayments$3 - $20 Medicare Part DMust be enrolled, with limited exceptionsMust be enrolled, no exceptions Part D premium Payments EPIC pays up to the basic amount for those with income up to $20,000 Single or $26,000 Married EPIC pays up to the basic amount for those with income up to $23,000 Single or $29,000 Married effective 7/1/2011 CoverageSecondary payer to Part D for all covered Part D drugs Primary Payer for Part D excluded drugs such as Benzodiazepines and Barbiturates (which will be covered by Part D beginning 2013) Secondary payer to Part D for all covered Part D drugs, for coverage gap claims only Primary Payer for Part D excluded drugs such as Benzodiazepines and Barbiturates (which will be covered by Part D beginning 2013), for coverage gap claims only

Eligibility To join EPIC, a senior must: -be a NYS resident 65 years of age or older -have annual income below $35,000 Single or $50,000 Married - not be receiving full Medicaid benefits - be enrolled or eligible to enroll in a Medicare Part D drug plan (no exceptions)

Summary of Changes Major changes to EPIC will take place January 1, 2012 EPIC will be a free program EPIC Fee and Deductible plans will be eliminated Members are required to enroll in a Part D drug plan and maintain coverage to receive EPIC benefits EPIC will provide supplemental prescription coverage only while in the Part D coverage gap: - Co-payments will range from $3 - $20 - Covers Part D approved drugs purchased in the coverage gap - Covers drugs in Part D excluded drug classes e.g. anti-anxiety (benzodiazepines) and anti-seizure (barbiturates) purchased in the coverage gap

Continued EPIC will pay the Medicare Part D premiums for members with income up to $23,000 or less Single or $29,000 or less Married EPIC will pay up to the basic benchmark (average cost) of a Medicare Part D plan in New York State, $39.79 per month in 2012 If income is above these levels, member will be responsible to pay the Medicare Part D premium each month EPIC will continue to help members apply for the Medicare Low Income Subsidy (LIS) Extra Help and Medicare Saving Programs (MSP) to save more. Those approved will pay the Medicare co- payment for drugs EPIC will continue to pay Part D premiums for partial LIS members and those with full LIS in enhanced plans

Special Enrollment Period EPIC members receive a Special Enrollment Period (SEP) that enables them to join Medicare Part D or make a change in their Part D drug coverage outside of the Annual Enrollment Period New EPIC members can use the SEP to enroll in a Medicare Part D drug plan All EPIC members can use the SEP to change their Part D plan once during the year

TCR and Extended Overrides The EPIC Temporary Coverage Request (TCR) Helpline will end on December 31, Members can receive up to a 90-day temporary supply of medication until December 31, 2011 if their doctor calls the TCR Helpline and attests that an appeal will be filed with the Part D plan - Members with extended overrides for drugs denied by the Part D plan appeal process will be notified that EPIC will not cover the drug after December 31, 2011

Communications -Letters to all 292,000 members were sent mid August notifying them of the program changes and that EPIC will not be creditable coverage (primary) in Notices to EPIC pharmacy providers and prescribers were sent by -Program changes were communicated to advocates and partners

Continued -Letters were sent to members in Medicare Advantage plans without Part D, encouraging them to contact their plan to enroll in a Part D option for Letters were sent to members that do not have a Medicare number on file, requesting them to provide the number to EPIC to help them enroll in drug coverage for Letters will be sent to members with union/retiree benefits encouraging them to contact their plan to learn about their drug coverage benefits for The EPIC website is being updated for the new program - A new EPIC brochure and application will be available in late fall

Information and Assistance EPIC Program Participant Helpline: (TTY ) Provider Helpline or Temporary Coverage Request (TCR) Line: Web: click on EPIC for Seniorswww.nyhealth.gov

What is New York Prescription Saver (NYPS)? A free pharmacy discount card that lowers prescription costs by as much as: - 67% on generic drugs - 24% on brand name drugs Ways to apply: -Online at -Print an application from the website, complete it and mail -By phone at

Who Can Join? -NYS residents who do not receive Medicaid -Age 50 up to 64 or -Persons with a disability and determined disabled by Social Security Administration (SSA) -Have an annual income under $35,000 (single) or $50,000 (married) based on prior year’s income

Information & Assistance NYPS Participant Helpline: (TTY ) Provider Helpline: Fax Number: Address: NYPS P.O. Box Albany, NY Web:

NY Bridge Program New York’s insurance plan for those with pre- existing medical conditions No deductibles Preventive care Low co-pays Pharmacy benefits Vision care Visit