Prescription Drugs

The cost of prescription drugs is rising at an unsustainable rate for individuals as well as for private and public health care programs. The increase in spending on drugs has risen by over 12% in the Medicaid program forcing the state to consider a number of cost containment measures.

New York State Legislative Initiatives to address this issue include:

- expansion of the EPIC (Elderly Pharmaceutical Insurance Coverage) program to include disabled persons. EPIC funds saved by a federal Medicare drug benefit should be used to finance this expansion and reduce fees for lower income beneficiaries.

- set payments for prescription drugs for state programs at no more than the average of those in a number of industrialized countries.

- use Preferred Drug Lists in New York State to reduce pharmaceutical costs, provided that adequate consumer safeguards are included protect patients from added risks and allow doctors to prescribe other drugs if necessary.

- increased oversight of pharmaceutical pricing practices which may be in violation of federal laws regarding Medicaid prices and with regard to maintaining lower prices for drugs developed through taxpayer funds from the National Institute on Health's research support.

At the federal level, HR2427 would allows the importation of prescription drugs into the United States from Canada and other specified countries by commercial entities including pharmacies.

EPIC and the new Medicare Rules

The arrival of the new Medicare Part D drug benefit presents New York's elected leaders with both a challenge and an opportunity to use the Elderly Pharmaceutical Insurance Coverage (EPIC) program. to protect seniors and people with disabilities from the unacceptably high cost of prescription drugs. While the Medicare Part D drug benefit provides increased access for Medicare beneficiaries who currently lack any drug coverage, it will be a substantial net loss for many beneficiaries in New York, especially for current EPIC and dually eligible Medicare/Medicaid enrollees.

EPIC is open to all NYS residents age 65 and older that meet income eligibility as follows: if you are single, with an annual income of $35,000 or less, or if you are married, with an annual joint income of $50,000 or less (there is no assets test). Those with Medicaid or with a drug benefit better than EPIC are not eligible. EPIC helps by setting fixed copayments for each prescription and limiting what you have to pay out-of-pocket each year. You pay a sliding fee or deductible to join EPIC. http://www.health.state.ny.us/nysdoh/epic/faq.htm.

EPIC WORKS endorsing organizations do not think it is acceptable that the long-anticipated arrival of Medicare Part D coincide with an erosion and roll-back of EPIC's protections. For us, it is equally unacceptable for New York's leaders to maintain EPIC's exclusion of non-elderly individuals with disabilities.

EPIC WORKS endorsing organizations call upon New York's leaders to seize the opportunity that Medicare Part D presents. The EPIC WORKS principles below are a road map for ensuring that New York's commitment to promoting access to affordable drug coverage is maintained where it now exists and realized where it doesn't.

As follows are the EPIC WORKS principles:

1. Coordination between EPIC and Medicare Part D plans should be seamless from the enrollee's perspective. Coordinating Part D plans should meet EPIC's goal to guarantee minimal changes for enrollees, no increased cost-sharing, continued access to EPIC's open formulary and comprehensive pharmacy network. In the event that coordination is not seamless and does not meet EPIC's goal, Medicare Part D participation should be voluntary for EPIC participants. Any auto-enrollment into Part D plans must provide the option to decline.

2. Non-elderly adults with disabilities qualifying for Social Security Disability Insurance (SSDI) should be included in the EPIC program on the same terms as seniors.

3. EPIC should lower the prices of prescription drugs by joining its purchasing power with that of other state-funded programs.

4. Savings that accrue from coordination with Medicare Part D should stay in the EPIC program and be used first to include the non-elderly SSDI disabled and to lower cost-sharing for participants.

5. A major portion of the $34 million in transitional assistance New York is receiving should be used to provide direct grants to community based organizations for education and case management of disabled and elderly individuals seeking assistance in the transition to Medicare Part D, particularly those facing language and other barriers.

6. Dually eligible elderly and disabled Medicare/Medicaid beneficiaries should receive the same level of protections from the inadequacies of the Part D benefit as EPIC enrollees.

Material Provided by Statewide Senior Action