AARP: New York state budget cuts will shift more medication costs to senior citizens Jan. 1

Staff reports

Seniors across New York State who have prescription drug coverage under the state’s EPIC (Elderly Pharmaceutical Insurance Coverage) program will see their benefit and other program assistance greatly reduced starting Jan.1. This is the second round of changes to the program resulting from over $36 million in funding cuts in the state budget.  Initial changes were implemented in July 2011.

“The reduction in EPIC coverage resulting from state budget cuts means seniors in New York State will most certainly be paying more for the medications they need,” stated Lois Wagh Aronstein, AARP New York State Director. “The average EPIC enrollee is 78 years old and takes four prescription drugs.  These changes shift a major burden onto these seniors, hitting them hard in these tough economic times.”

As part of the latest round of changes, EPIC will only provide prescription drug coverage once an enrollee falls into the Medicare prescription drug coverage gap (also known as the “doughnut hole”), with an exception only for those with the lowest  income.  The “doughnut hole” starts when the total drug cost reaches $2,930 for an individual.

For many enrollees the changes mean EPIC will no longer provide:

• Assistance with paying co-payments for prescriptions until an enrollee reaches the Med-icare Part coverage gap;  

 • Assistance with covering Medicare Part D premiums and deductible;

• Help for EPIC enrollees in choosing the best Medicare Part D Plan for their prescription  drug needs;

• Emergency coverage if a claim is denied at the pharmacy counter – an EPIC enrollee could leave the counter without his or her medication.

A set of initial changes to the EPIC program was implemented in July 2011.  The majority of changes were positive for low-income populations.  

They included raising the Medicare Part D premium assistance income levels to $23,000 if single and $29,000 if married.  

“Essentially, the recent state budget changed the majority of coverage for most EPIC enrollees.  The program will only provide assistance now when an enrollee falls into the doughnut hole,” continued Aronstein.  

New York State has approximately 292,000 EPIC enrollees that could be impacted by these changes.  AARP’s Public Policy Institute’s Rx Price Watch Report has documented, that as of March 2010, inflation had dropped while the manufacturer prices of the brand name prescription drugs most widely used by Medicare beneficiaries increased by an average of 9.7 percent.

AARP is encouraging its members to call Gov. Cuomo on a toll-free number 1-888-374-2742 to encourage him to restore funding for EPIC in his budget plan for next year.