Copay Assistance Helps New York Seniors, Notes New York Elder Law Attorney
Feb 19, 2013
White Plains, NY (Law Firm Newswire) February 18, 2013 – New York seniors are getting a prescription price break.
According to the AARP, almost 300,000 New York seniors enrolled under the state’s Elderly Pharmaceutical Insurance Coverage (EPIC) program are slated to receive co-payment assistance this year. Co-payment assistance, canceled due to budget constraints, was restored in the state’s budget as of January 1, 2013, though funding past March 31, 2013 has yet to be determined.
The AARP New York State Manager of Government Affairs, David McNally, stated that EPIC is one of New York’s most essential programs for seniors, and he applauds the reestablishment of funds to help seniors afford their much-needed medication.
EPIC reports that the average enrollee using their co-payment assistance is female, 78 years old, and taking four prescription medications. As of January 1, for any senior eligible for EPIC, co-payments will return to their previous cost of no more than $20 per prescription.
Without co-payment assistance, many seniors must pick and choose which medications they can afford to have filled, skipping the more expensive medications, often to the detriment of their health. The AARP works to help all seniors get the medication they need; EPIC’s previous budget constraints meant that financial help only kicked in when a senior had reached Medicare Part D’s coverage gap, commonly known as the “doughnut hole.”
Medicare’s part D coverage gap kicks in for seniors when their total retail drug costs reach between $1,800 and $2,970 (the ceiling amount differs from plan to plan) — the total retail cost of the medications, not the total amount paid by the patient. When a patient reaches the end of their initial coverage limit, they remain in the “doughnut hole” until their out-of-pocket expenses exceed $4,750, not including the portion of their prescription expenses paid by their insurance carrier or monthly Medicare Part D plan premiums.
Eligibility requirements for EPIC include being 65-years of age or older, have New York State residency, an annual income below $35,000 if single or $50,000 if married, and enrollment in or eligibility for Medicare Part D plan (no exceptions), without full Medicaid benefits.
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