EPIC Printable Application
You can print out the EPIC application through our website to start the process, as fast as possible. Learn more below:
- Download the printable PDF from the link below
- Fill out the application
- Mail completed application to the address provided
Not Medicare Part D eligible?
Anyone not eligible for Medicare Part D is still eligible for our 6/12 Program and can still save money.
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Save money on your medications with EPIC
The Elderly Pharmaceutical Insurance Coverage (EPIC) program, offered by the New York State Department of Health, helps more than 270,000 income-eligible seniors. The EPIC program helps supplement the out–of–pocket cost for Medicare Part D drug plans.
What are the basic requirements for EPIC?
- New York State resident age 65 or older
- Annual income below $35,000 (single) or $50,000 (married)
- Enrolled or eligible to be enrolled in a Medicare Part D plan (no exceptions), and
not receiving full Medicaid benefits
What does EPIC cover?
- New prescriptions and refills
- Insulin, insulin syringes, and needles
- Brand name and generic prescription drugs
- Quantities up to your Part D plan’s limits
Learn More about the EPIC program