Spending Too Much on Prescription Drugs? There’s Always Help When You Need It

Programs designed to help with the cost of medications

By Susan Suben

We’re living through a crisis that probably none of us have ever seen in our lifetime. It is testing our strength financially, socially and emotionally.

Yet we need to remain positive and look for things that we can celebrate, that inspire us and that can ease some of our hardships and concerns.

As we try to return to a “new normal,” we may be seeking financial assistance information that will help us move from this phase to the next as easily as possible. With that in mind, I would like to tell you about two prescription drug programs that could help with the cost of your medications — EPIC and Good Rx.

EPIC stands for Elderly Pharmaceutical Insurance Coverage. It is administered by the NYS Department of Health. It provides secondary coverage for Medicare Part D, which is the Medicare prescription drug program after the Part D deductible, if any, is met. It can help enrollees pay for their Medicare Part D premium, deductibles, co-pays and coverage gap depending upon earned income. It also covers many Part D excluded drugs.

To be eligible to join, you must be a NYS resident, age 65 or older, have an annual income below $75,000 (single) or $100,000 (married) and be enrolled or eligible to be enrolled in a Medicare Part D plan. You can sign up for EPIC anytime during the year through what is called a special enrollment period (SEP).

Covered drugs must be in your Part D formulary. After you satisfy any Medicare Part D deductible, EPIC will cover new prescriptions and refills; insulin, insulin syringes and needles; brand name and generic prescription drugs; and quantities up to your Part D plan’s limits.

You must use a participating pharmacy in NYS to receive EPIC benefits. That means your pharmacy must participate in both EPIC and your Medicare Part D drug plan to maximize your benefits. There are some mail order pharmacies that also participate.

EPIC has two plans based on your prior year’s income. The plan is for members with income up to $20,000 (single) or $26,000 (married). The deductible plan is for members with incomes ranging from $20,001 to $75,000 (single) or $26,001 to $100,000 (married).

The fee plan has an annual fee that ranges from $8 to $300 per person. If you have a Part D deductible, you must satisfy it. After your Part D deductible is met, fee plan members will only have to pay the EPIC co-payment for drugs. Co-payments range from $3 to $20. There is automatic coverage in your Part D coverage gap. You will also receive Part D premium assistance up to the amount of $36.55 per month, which is the average cost for Part D premiums.

The deductible plan has no fee to join but there is an annual EPIC deductible that must be met based upon your last year’s income. It ranges from $530 to $3,215. You must pay the full price for your Part D drugs until you meet your Part D plan’s annual deductible. EPIC will track how much you spend. Drug costs in the Medicare Part D deductible phase cannot be applied to the EPIC deductible. There is a deductible schedule online. Once you satisfy both deductibles, you will only pay the EPIC co-pays ranging from $3 to $20 based on the cost of your drug.

Many of my clients join the deductible plan even if they do not currently need assistance. There is no out-of-pocket cost to do so and it’s a way to plan for future drug expenses.

Good RX is a discount program. Prescription drugs are not regulated and can vary substantially in cost. Good RX checks more than 75,000 pharmacies in the US to monitor prescription drug prices and provides free drug coupons for discounts on medications. It finds the lowest drug prices at pharmacies in your area.

The company has a free to use website and mobile app. You can sign up for a card online. There are no fees or expiration dates and every member of your family is entitled to the discount.

Once you receive your card, type your prescription on the home page. You will be able to see the pharmacy near you that can fill your prescription at the lowest cost. Print out the coupon or post it to your phone and take the coupon to your pharmacist to take advantage of the discount. It’s a simple process and the coupon will work with your insurance and Medicare.

Know that there is always help available when you need it.

Let’s remain positive. Let’s praise the dedication of our first responders, stay connected with friends and family, and help those who are vulnerable in our community.

Susan Suben, MS, CSA, is president of Long Term Care Associates, Inc. and Elder Care Planning. She is a consultant for Canandaigua National Bank & Trust Company. She can be reached at 800-422-2655 or by email at susansuben@31greenbush.com.