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Case Studies Part D Prescription Drug

“Having this EPIC plan was a miracle; an absolute miracle.”

Only a fraction of the nearly 3 million New York State residents aged 65 and older are enrolled in the state’s pharmaceutical assistance program known as New York EPIC.

When I meet with New York Medicare Part D clients, I ask if their individual income is below the $75,000 threshold, $100,000 if married. If so, I advise enrolling in EPIC even if they don’t take any or have only inexpensive medication.  Because, as Schenectady County, New York resident Beth says, “You never know.”

Beth shares her story. The $20,000 per dose medication.

In this 16 minute interview Beth shares her story of how she originally enrolled in EPIC and didn’t use it. She explains how her doctor prescribed a specialty medication. And how that medication was not included on her Medicare Part D plan formulary, its list of covered medications. And when she learned the drug would require a special exception approval from her Medicare Part D plan and costs $20,000 per dose, she was relieved to hear that EPIC would help. Listen in as Beth explains how affordable this $20,000 medication became after EPIC’s help.

Beth: “To me, having this EPIC plan was miracle, an absolute miracle. Because I wouldn’t have been able to get that drug and I would still remain very ill.”

If you reside in New York State, are age 65 or above, and have questions about how EPIC and your Medicare Part D plan can work together, please call (518) 346-2115.

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2 replies on ““Having this EPIC plan was a miracle; an absolute miracle.””

[…] Q: I live in New York State and belong to EPIC. My co-pays are different from what is shown above, why? A: A handful of states offer a State Pharmaceutical Assistance Program like New York’s EPIC. These SPAP programs include conditions (perhaps a fee or its own deductible) after which your co-pay levels are capped. In New York, for example, qualified EPIC members pay no greater than $20 for medications included in their plan’s formulary. (Learn more about EPIC here.) (Listen to my interview with Beth about her amazing EPIC experience.) […]

[…] Q: I’m still struggling to pay the 35% (brand) and 44% (generic) coinsurance. What financial assistance is available? A: A handful of states offer a State Pharmaceutical Assistance Program like New York’s EPIC. These SPAP programs include conditions (perhaps a fee or its own deductible) after which your co-pay levels are capped. In New York, for example, qualified EPIC members pay no greater than $20 for medications included in their plan’s formulary. (Learn more about EPIC here.) (Listen to my interview with Beth about her amazing EPIC experience.) […]

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