LIVERPOOL, NY (WSYR-TV) - Many seniors are dealing with sticker shock as the state's discount drug program, EPIC, changed the rules this month. Betty Palmer's pharmacist delivered the bad news.
"Save yourself a trip," he said. Your medication with this new law is going to be over $200," Palmer recalled.
She used to pay $20 to pick up a 3-month prescription of her most expensive blood pressure medication. That discount level is essentially gone for now, after the state slashed funding for EPIC. There was more bad news from her doctor, when Palmer asked for a less expensive generic brand.
"You can't change it because you can't take all medications with your allergies and that is the only one that will work for you," Palmer was told.
Similar stories are emerging after new rules for EPIC took effect on January 1, 2012.
While there is no longer a cost to enroll, members must have a Medicare Part D plan and that can carry a monthly insurance fee.
Also, the EPIC discount doesn't kick in for out-of-pocket expenses until a total retail value of $2,930 has been reached on drugs. The Medicare enrollee would generally only be responsible for a portion of that cost, depending on their insurance plan.
The $2,930 limit is based on the starting point of the so-called Medicare "doughnut hole", when Plan D coverage becomes more limited. Once retail drug costs reach another plateau, seniors may be deemed eligible for much lower contributions through "catastrophic coverage".
The restrictions slash help for many of the 280,000+ seniors who use EPIC. AARP reports that 190,000 enrollees will see benefits reduced to "doughnut hole" levels and 4,000 others will no longer be eligible. Medicare Part D Plans can be changed once a year and AARP Volunteer Robert O'Connor says it's worth reviewing the options.
"If some of their drugs are not covered in their present plan, we could find a plan where they were covered...less of a deductible, maybe less per month," said O'Connor.
As AARP lobbies the state for relief, Betty's doctor will give out office samples of her medicine to get through next month.
"Down the line, a year or whatever, who knows what is going to happen!" said Palmer. "They consider me with my finances, poverty level. What do you do?"
O'Connor said free counseling to review insurance plans is often available for seniors through their local county's Office for the Aging.
