Provider Bulletin

P.O. Box 15018
Albany, New York 12212
(800) 634-1340

BULLETIN NO. 12-02 August 2012

SUBJECT: EPIC Program Changes

Beginning January 1, 2013, many EPIC program benefits will be restored. This bulletin provides information about these changes as well as how they will affect both your EPIC customers and your pharmacy.

All members must be enrolled in a Medicare Part D plan in order to receive EPIC benefits.


  • EPIC will provide secondary coverage for EPIC and Medicare Part D covered drugs after any Part D and/or EPIC deductible is met. EPIC will also cover many Medicare Part D excluded drugs, e.g. prescription vitamins, prescription cough and cold preparations.
  • Low Income Subsidy (LIS) members will be able to use EPIC during all Medicare Part D benefit stages.
  • Any amount paid toward the Medicare Part D deductible cannot be applied to the EPIC deductible.
  • The EPIC manufacturers' rebate program is being reinstated.

EPIC Participant Eligibility:

  • The Fee Plan will be restored. Members with full Low Income Subsidy (LIS) will have their EPIC fees waived. EPIC co-payments will continue to range from $3 - $20 based on the cost of the drug.
  • The Deductible Plan will be restored. EPIC members with higher incomes will be responsible for paying their own Medicare Part D premium. However, their EPIC deductible will be lowered by the annual cost of a basic Medicare Part D drug plan.
  • EPIC will continue to pay Medicare Part D premiums, up to the amount of a basic plan, for members in the Fee and Deductible plans with income up to $23,000 (single) or $29,000 (married).

Attached you will find a copy of the Good News letter mailed to EPIC members. If you have any questions, please contact the EPIC Provider Helpline at (800) 634-1340.