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Discount Drug Card For
EPIC Enrollees
Not Eligible for Low
Income Assistance
INFORMATION FACT SHEET
The following two EPIC enrollees are
comparing their current EPIC plans with
two potential discount drug cards. Each
senior takes the same two drugs, but due
to their income levels pay very
different out of pocket expenses. Senior
A learns after her comparison that EPIC
is the best plan for her. She will stay
in the EPIC program and not join a
Medicare Discount Card plan. Senior B,
however, learns that Discount Card #2
will actually save him more than $150
over EPIC. He will stay in the EPIC
program, but also join Discount Card #2.
This example clearly indicates that EPIC
enrollees should investigate whether or
not a discount card will provide them a
better discount based on their
medications, their income, and their
current EPIC plan.
EPIC Senior A
Annual Income - $16,500 -
ineligible for the low income
assistance credit from Medicare
Enrolled in the EPIC Fee Plan -
pays an annual fee of $140 based on
income level
Currently takes two prescription
drugs
º Atenolol (cardiovascular
disease medication)
º Anaprox (arthritis
medication)
Pays a $20 co-pay per drug,
per refill and has both drugs
refilled 4 times each year
Annual pharmacy cost of
prescriptions would be $925 without
any discount program
º
Atenolol - $540/year
º
Anaprox - $385/year
| |
EPIC Senior A |
| |
EPIC Only |
Discount
Card #1 |
Discount
Card #2 |
|
Out of Pocket
Expenses: |
|
|
|
|
Annual EPIC Fee |
$140.00 |
$140.00 |
$140.00 |
|
Annual Card Fee |
--- |
$19.95 |
$30.00 |
|
Annual Deductible |
$0.00 |
$0.00 |
$0.00 |
|
Annual Co-pay |
$160.00 |
$0.00 |
$0.00 |
|
Pharmacy Drug
Costs without ANY discount: |
$925.00 |
$925.00 |
$925.00 |
|
Out of Pocket
Subtotal: |
$300.00* |
$1,084.95 |
$1,095.00 |
|
Savings: |
|
|
|
|
EPIC |
$625.00 |
--- |
--- |
|
Atenolol |
--- |
15% or $81 per
year |
25% or $135 per
year |
|
Anaprox |
--- |
0% |
15% or $58 per
year |
|
Savings
Subtotal: |
$625.00 |
$81.00 |
$193.00 |
|
TOTAL EXPENSES
|
$300.00* |
$1,003.95** |
$902.00 |
|
TOTAL SAVINGS |
$625.00 |
($78.95)** |
$23.00 |
* EPIC enrollees in the Fee
Plan only pay their fee and
their co-pays out of pocket, and the
remainder of their expenses are paid by
EPIC.
** With Discount Card #1, Senior A
must pay the EPIC fee and
the discount card fee in order to
remain in both plans. The total savings
with the plan is only $81, for one of
the two drugs. The other is not
discounted by the card at all. As a
result, Senior A will actually spend
more out of pocket than the
actual pharmacy costs of the drugs.
EPIC Senior B:
Annual Income - $32,000
-ineligible for low income
assistance from Medicare
Enrolled in the EPIC Deductible
Plan - must meet a $960 deductible
before EPIC
discounts
begin
Currently takes two prescription
drugs
º Atenolol (cardiovascular
disease medication)
º Anaprox (arthritis
medication)
Will only pay co-pays when the
annual deductible has been met
Annual pharmacy cost of
prescriptions would be $925 without
any discount program
º
Atenolol - $540/year
º
Anaprox - $385/year
| |
EPIC Senior B |
| |
EPIC
Only |
AARP Card |
Aetna
Card |
|
Out of Pocket
Expenses: |
|
|
|
|
Annual EPIC Fee |
$0.00 |
--- |
--- |
|
Annual Card Fee |
--- |
$19.95 |
$30.00 |
|
Annual Deductible |
$960.00* |
$960.00** |
$960.00** |
|
Annual Co-pays |
$0.00 |
$0.00 |
$0.00 |
|
Pharmacy Drug
Costs without ANY
discount: |
$925.00 |
$925.00 |
$925.00 |
|
Out of Pocket
Subtotal: |
$925.00 |
$944.95 |
$955.00 |
|
Savings: |
|
|
|
|
EPIC |
$0.00 |
--- |
--- |
|
Atenolol |
--- |
15% or $81 per
year |
25% or $135 per
year |
|
Anaprox |
--- |
0% |
15% or $58 per
year |
|
Savings
Subtotal: |
$0.00 |
$81.00 |
$193.00 |
|
TOTAL EXPENSES
|
$925.00 |
$863.95 |
$762.00 |
|
TOTAL SAVINGS
|
$0.00* |
$61.05 |
$163.00 |
*Under EPIC, Senior B will receive no
savings because the total pharmacy cost
of $925 does not meet the annual
deductible of $960. This deductible must
be met before EPIC benefits begin.
**The EPIC deductible will still
apply for those who choose to join a
discount card.
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