Important Notice: Attention Prescribers

October 2011

Effective January 1, 2012, the Elderly Pharmaceutical Insurance Coverage (EPIC) program will change as follows:

  • EPIC will be free. There will be no fees or deductibles.
  • EPIC will only be available to those who have Medicare Part D as their primary drug coverage.
  • EPIC will only cover Part D covered drugs that are purchased while in the Medicare coverage gap (donut hole).
  • Before reaching the coverage gap, members will be responsible for paying the price charged by their Part D plan.
  • EPIC co-payments for covered claims paid in the coverage gap will be $3 - $20, depending on the cost of the drug.
  • EPIC will no longer cover drugs that were denied by the Part D plan after two levels of appeal.
  • EPIC will continue to cover Medicare Part D "excluded drugs", such as benzodiazepines and barbiturates, while in the coverage gap.

If your patients are currently receiving drugs that are not on their Part D formularies, please discuss alternative drug therapies that will be covered by their Part D plans in 2012. Prescribing drugs on the Medicare Part D formulary will maximize coverage and reduce your patients' out of pocket expenses.

EPIC sent a letter to members explaining these program changes. If you have patients who have questions about how these changes will affect them, please have them contact the EPIC Participant Helpline at (800) 332-3742.

If you have any questions or require further assistance please contact the EPIC Provider Helpline at (800) 634-1340.