What EPIC actually is
New York runs its own pharmaceutical assistance program for older residents. It does not replace Medicare Part D and it is not insurance you shop for. It is a state subsidy that sits behind your Part D plan and pays down what you are left owing at the counter.
Two things happen once you are in.
Premium help, if your income is low enough. EPIC helps pay the Medicare Part D drug plan premium for members with income up to $23,000 if single or $29,000 if married.
Coinsurance help, all year. After the Part D deductible is met, EPIC subsidises coinsurance year round. The effect a member notices is the copay ceiling: no higher than $20 per drug, with EPIC covering the rest.
Who qualifies
That upper figure is the reason this page exists. A retired couple with $90,000 of income does not think of themselves as needing a state assistance program, and they are inside the Deductible Plan.
What you pay
The copay you owe with EPIC helping depends on the cost of the drug, on a short published scale:
| Cost of the drug | Your EPIC copay |
|---|---|
| Up to $15 | $0 to $3 |
| $15.01 to $35 | $7 |
| $35.01 to $55 | $15 |
| Over $55 | $20 |
That is the whole scale. The $20 line is the one that matters most: it is the ceiling regardless of how expensive the medication is.
Members in the Fee Plan pay an annual fee based on income. Members in the Deductible Plan meet an annual deductible before EPIC coverage begins, again scaled to income. Both structures are published by the state, and the helpline will tell you your own figure before you commit.
How to apply
- Confirm the three basics: 65 or older, New York resident, and enrolled in or eligible for a Medicare Part D plan.
- Get the application. Online at the state health department’s EPIC pages, or by calling 1-800-332-3742 (TTY 1-800-290-9138) and asking them to mail one.
- Fill it in and send it. Mail or fax. No documentation is required with it. EPIC verifies income with the Social Security Administration and the New York State Department of Taxation and Finance.
- Apply in any month. There is no season for EPIC, unlike Part D itself.
- Keep the card with your insurance cards and hand it over at the pharmacy counter along with the Part D card.
The lack of a document requirement is unusual enough to be worth repeating: the most common reason people abandon a benefit application in New York is the paperwork, and this one does not have any.
How EPIC fits with everything else
With Medicare Part D: required. EPIC sits behind Part D and needs it to exist.
With Extra Help: they are different programs and they coexist. Extra Help is federal, applied for through Social Security, and gives a $0 Part D premium and low fixed copays to people under 150% of the federal poverty level. EPIC is the state layer, and its income limits go far higher. Someone can have both. How Extra Help works.
With a Medicare Savings Program: also different, also compatible. MSPs pay the Part B premium and, at the lowest level, deductibles and coinsurance too. New York applies no asset test to them. Anyone looking at EPIC should check MSP eligibility in the same sitting. The savings programs.
With full Medicaid: the picture is different, because Medicaid drug coverage runs on its own track through NYRx. Ask the EPIC helpline about your specific situation rather than assuming either way.
What we are not publishing here
The exact Fee Plan fee schedule and the Deductible Plan deductible amounts are set on income bands that we are not reproducing, for one reason: they are long, they are revised, and a stale number on this page would be worse than none. The helpline gives you your own figure in one call, and the state publishes the current schedule.
Questions people ask
What is EPIC in New York?
A state program that helps New York residents 65 and older pay for prescription drugs. It works alongside Medicare Part D rather than replacing it.
What is the income limit for EPIC?
The Fee Plan goes to $20,000 single and $26,000 married. The Deductible Plan goes from there to $75,000 single and $100,000 married.
How much will my prescriptions cost with EPIC?
Copays run from $0 to $20 depending on the price of the drug, with $20 as the ceiling even for expensive medications.
Do I need Medicare Part D to join EPIC?
Yes. You must be enrolled in a Part D plan or eligible to enrol in one.
What documents do I need to apply?
None with the application. EPIC verifies income directly with Social Security and the state tax department.
When can I apply?
Any month of the year. Call 1-800-332-3742 or apply online.
Can I have EPIC and Extra Help at the same time?
They are separate programs, one state and one federal, and they can coexist. Ask the helpline how they interact in your case.
Sources
- NYS Department of Health — EPIC program (checked 2026-09-08)
- NYS Department of Health — EPIC eligibility requirements (checked 2026-09-08)
- NY Health Access — EPIC (checked 2026-09-08)
More in Prescription Costs in New York: Who Pays and What Caps Exist
- Insulin Costs Nothing in New York Now. If You Are Being Charged, Here Is Why — Since January 1, 2025 New York bans all cost sharing on prescription insulin: no deductible, no copay, no coinsurance. Which plans it covers, which it does not, and what to say at the counter.
- NYRx: Why Your Medicaid Pharmacy Claim Stopped Going Through Your Plan — Since April 1, 2023 the Medicaid pharmacy benefit in New York runs through NYRx, the state program, instead of through managed care plans. What changed, who is exempt, and what to do at the counter.
- Your Plan Will Not Cover the Drug: The Order of Operations — A formulary denial is a process, not a verdict. Which of the five rejection reasons you actually got, who has to fix each one, and the appeal route for commercial, Medicaid and Medicare.
This page explains how the system works. It is not medical advice. More.