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Seniors lobby to keep prescription benefit

Discount hinges on Tuesday budget announcement

Sunday, January 20, 2013
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— Low-income seniors are hoping Gov. Andrew Cuomo’s state budget address on Tuesday includes continued support for their prescription drug expenses.

About 300,000 seniors are paying no more than a $20 copayment for medications during the first three months of the year as part of the state’s Elderly Pharmaceutical Insurance Coverage program, which had its copayment assistance partially funded in the last state budget. This assistance, which is estimated to cost the state about $120 million for a full year, could run out at the start of April if it’s not in the state’s next budget.

If the state’s new fiscal year starts without this copayment assistance program being funded, EPIC enrollees would likely be responsible for paying 25 percent of the cost of their drugs, which in some cases would triple or quadruple their current out-of-pocket expenses.

“We’re advocating that the governor include in his budget [on Tuesday] the continuation of this important copayment assistance,” said Bill Ferris, the New York State legislative representative for AARP.

The governor will outline his budget at the Egg Center for Performing Arts on Tuesday afternoon. This will start a budget process that will include the state Senate and Assembly submitting counter budgets, with a final budget due by April 1, which is the start of the fiscal year.

EPIC enrollees include seniors who are at least 65 and are single with an income below $35,000 a year or married with an income below $50,000. The program is secondary coverage to the federal government’s Medicare Part D program and copayments range from $3 to $20 when copayment assistance is provided under EPIC.

The restoration of copayment assistance for the first three months of 2013 was driven by the state Senate, as the Assembly and Gov. Andrew Cuomo left it out of their budgets in 2012. The state Senate had proposed putting almost $50 million into the program, but three-way negotiations led to a $30.6 million investment for the first three months of 2013.

Ferris argued that it was essential to avoid the massive price increases that popped up last year when low-income seniors saw their drug prices go way up. “They were literally getting sticker shock at the counter of their local pharmacy,” he said of the assistance cut in 2012.

“We knew this was a bad cut,” Ferris said, “But we didn’t know the magnitude of the cut until we started hearing from the grown children of EPIC enrollees.”

According to the most recent annual report from the state Department of Health on EPIC, there are more than 20,000 people from the Capital Region enrolled in the program.

Fulton County had 1,771 participants, Montgomery County had 2,062, Saratoga County had 3,727, Schenectady County had 2,576 and Schoharie County had 862.

The most commonly used drugs by EPIC enrollees, based on the latest state report, is Plavix, which prevents blood clots; Omeprazole, which deals with stomach problems; and Furosemide, a diuretic.

 
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