NYPS is a free prescription discount card that will help people who are under age 65 so are too young for EPIC save on the cost of prescription drugs. The card is sponsored by NYS and the discounts are provided by pharmacies and manufacturers. Unlike EPIC, the discount card doesn't actually PAY for the drug. It simply gives the consumer the benefit of the same discounted price that EPIC negotiates for its members. It can lower the cost of prescriptions by as much as 60 percent on generics and 30 percent on brand name drugs.
There is a growing network of pharmacies participating in this program. There are now 4,000 pharmacies in this network, which includes a large percentage of independent drug stores and all major chain stores.
The card is for New York State residents who are:
- 50 to 64 years old, or
- Persons who are under age 50 and have a disability. (People who get Social Security Disability benefits must wait two years until they become eligible for Medicare and Medicare Part D, so it will be useful in that 2-year waiting period).
What are the income limits?
They are the same limits as EPIC
- $35,000 annual income for a single person
- $50,000 annual income for a couple
These income limits are based on what you earned in 2008. You do not have to send proof of your income.
Where can someone apply?
- You can apply online at http//:nyprescriptionsaver.fhsc.com,
- You can print a paper application and mail it to--NYPS, P.O. Box 12069, Albany, New York 12212-2069, or
- You can call NYPS Helpline at 1-800-788-6917, and a representative will take an application over the phone
After someone applies, how long will it take him/her to receive the NYPS card?
- Just two weeks!
If someone has a disability, how does he/she inform the NY Saver Program of the disability?
- You should check "yes" on the question for Disability Status on the NYPS application if you have been determined to be disabled by Social Security Administration or ODTA. You can refer to your award letter from SSA or OTDA.
Can I enroll in the NYPS card if I have Medicaid?
- You can enroll only if you are on Medicaid with a Spend Down
Can I enroll in the NYPS card if I have Medicare?
- People with disabilities under age 65 may use this card even if they also have Medicare Part D, to fill some of the gaps in Part D coverage.
How will this card benefit someone with a disability under age 65 who is also enrolled in a Medicare Part D plan?
- The NYPS card can be used to purchase those drugs in categories not covered by Part D. This would include barbiturates, benzodiazepines, prescription cough-and-cold, and prescription vitamins.
- The NYPS card can be used to purchase drugs that are not on the Part D formulary. (Though be sure to help them appeal to the Part D plan to request an “exception” and cover the drug – EFLRP can help with that).
- They can also use the card during the gaps in Part D coverage – when they have a deductible, or during the “coverage gap” or “doughnut hole.” But – this is tricky. See the next question.
Can someone use the NYPS card and his/her Part D plan at the same time?
- No, you are only allowed to use one “discount” card per drug purchase. You might have the NYPS card and a Part D plan card, but you must choose which one you will use per drug purchase. During the deductible period and the coverage gap or “doughnut hole,” you have a choice --
- You can use your Part D plan card and get your medications at your plan’s discounted prices OR
- You can use the NYPS card.
- What difference does it make which of these choices you make?
o If you use your Part D plan card during the Part D deductible period and coverage gap, then the cost of every drug you purchase using the Part D card will be applied toward meeting the Part D deductible or toward getting out of the doughnut hole/coverage gap. The out-of-pocket costs of drugs purchased during these periods is called “TROOP” (true out of pocket) costs. Only drugs purchased using the Part D card count toward “TROOP” automatically.
o If you use the NYPS card during the deductible period and/or coverage gap instead of your Part D plan card, the amount you pay for drugs will still count as “TROOP” to help you meet your Part D deductible or get you out of the doughnut hole. However, the computers will not count up these costs automatically, unlike when you use the Part D plan card. You will be responsible for submitting paper receipts of the drug purchase to the Part D plan in order to have the amount included in the true out of pocket (TROOP) accumulation. You should contact your plan to find out about the paper receipt submission procedures.
For someone who is on the NY Prescription Saver Program and soon will be eligible for EPIC, how will he/she transition into EPIC?
- When a person becomes age 64 and 10 months, EPIC will mail him/her a letter with an EPIC application advising him/her that he/she will be eligible for EPIC when they turn 65.
- If you apply for EPIC, you can hold on to your NYPS card, but you can only use one “discount” card at a time per drug purchase.
Does NYPS have its own formulary?
- Yes, it is the same as EPIC’s. https://nyprescriptionsaver.fhsc.com/asp/druglisting.asp
Contact the Evelyn Frank Legal Resources Program with any questions:
Paula Arboleda—212-971-7645— firstname.lastname@example.org