Transcript Panel-IV-EPIC-Cooper1

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
New Program
Effective 7/1/11 & 1/1/12
Benefits
Before Program Changes
Income Limits
$35,000 Single $50,000 Married
$35,000 Single $50,000 Married
EPIC Fee
$8 - $300
None
EPIC Deductible
$530 - $1,715
None
EPIC Copayments
$3 - $20
$3 - $20
Medicare Part D
Must be enrolled, with limited exceptions
Must 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
Coverage
Secondary payer to Part D for all covered Part D
drugs
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)
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 copayment 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,
2011
- 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
2012
- Notices to EPIC pharmacy providers and prescribers
were sent by email
- 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
2012
-
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 2012
-
Letters will be sent to members with union/retiree benefits encouraging
them to contact their plan to learn about their drug coverage benefits for
2012
-
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: 1-800-332-3742
(TTY 1-800-290-9138)
Provider Helpline or Temporary Coverage Request
(TCR) Line:
1-800-634-1340
Web: www.nyhealth.gov, click on EPIC for Seniors
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 http://nyprescriptionsaver.fhsc.com
- Print an application from the website, complete it
and mail
- By phone at 1-800-788-6917
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: 1-800-788-6917
(TTY 1-800-290-9138)
Provider Helpline:
1-800-785-4922
Fax Number:
1-800-774-7493
Address:
NYPS
P.O. Box 12069
Albany, NY 12212-2069
Web:
http://nyprescriptionsaver.fhsc.com
NY Bridge Program
• New York’s insurance plan for those with preexisting medical conditions
• No deductibles
• Preventive care
• Low co-pays
• Pharmacy benefits
• Vision care
• Visit www.nybridgeplan.com