New York EPIC Prescription Assistance
EPIC is New York's drug assistance program for residents 65 and older. It works on top of a Medicare Part D plan to lower what you pay at the pharmacy.
New York residents 65 or older can join EPIC with income up to $75,000 if single or $100,000 if married. You must be enrolled in a Medicare Part D drug plan. EPIC then lowers your copay on covered drugs to $3, $7, $15 or $20, and for many members it also pays the Part D premium.
What EPIC Does
EPIC (Elderly Pharmaceutical Insurance Coverage) is run by the New York State Department of Health. It is secondary coverage. Your Medicare Part D plan pays first, and EPIC picks up part of what is left.
- Lower copays. After you meet your Part D plan's deductible, if it has one, you pay an EPIC copay of $3, $7, $15 or $20 for each covered drug. Which one depends on the cost of the drug.
- Drugs your plan leaves out. EPIC covers many drugs that Part D plans exclude. You pay the same EPIC copay for those.
- Part D premium help. For many members EPIC pays the monthly Part D premium, up to $58.82 a month in 2026. That is the average cost of a basic Medicare drug plan.
The Two Plans: Fee Plan and Deductible Plan
You do not choose a plan. EPIC places you in one based on your income from the previous year.
| Fee Plan | Deductible Plan | |
|---|---|---|
| Income if single | Up to $20,000 | $20,001 to $75,000 |
| Income if married | Up to $26,000 | $26,001 to $100,000 |
| Cost to join | A yearly fee of $8 to $300, set by income | No fee |
| Before EPIC copays begin | Your Part D plan's deductible, if it has one | An EPIC deductible of $530 to $3,215 a year, set by income |
| Part D premium | EPIC pays it, up to $58.82 a month | EPIC pays it if your income is up to $23,000 single or $29,000 married. Above that, you pay it yourself. |
For married couples, the fee or deductible applies to each person. If you have full Extra Help from Medicare, EPIC waives the Fee Plan fee.
Deductible Plan members who pay their own Part D premium get something in return: EPIC lowers their deductible by about $706, roughly a year of basic Part D premiums. The amounts in the table below already include that reduction.
What You Would Pay at Different Incomes
These figures come straight from the 2026 EPIC schedules for a single person. Use last year's income to find your row.
| Income last year (single) | Plan | You pay EPIC | Who pays the Part D premium |
|---|---|---|---|
| $12,500 | Fee | $54 a year | EPIC |
| $18,500 | Fee | $200 a year | EPIC |
| $22,500 | Deductible | First $580 of drug costs | EPIC |
| $30,000 | Deductible | First $900 of drug costs | You |
| $50,000 | Deductible | First $1,680 of drug costs | You |
| $75,000 | Deductible | First $2,430 of drug costs | You |
Married couples have their own schedule. Fee Plan fees run from $8 to $300 per person on joint income up to $26,000, and Deductible Plan deductibles run from $650 to $3,215 per person on joint income up to $100,000.
One rule catches people out. What you spend while you are still in your Part D plan's deductible does not count toward the EPIC deductible. Spending counts toward the EPIC deductible only after the Part D deductible is behind you.
Is EPIC Worth Joining?
In the Fee Plan, almost always. The highest fee is $300 a year. EPIC paying a basic Part D premium is worth up to about $706 a year, before you count a single lower copay.
In the Deductible Plan, it depends on your prescriptions. There is no fee, so joining costs nothing. But EPIC copays begin only after your drug spending for the year passes your EPIC deductible. If you take few medicines and your yearly drug costs stay under that figure, EPIC will not change what you pay. If you take a costly brand-name drug, you can pass the deductible early in the year and pay $20 or less per fill after that.
Who Qualifies
- You are 65 or older.
- You live in New York State.
- Your income last year was $75,000 or less if single, or $100,000 or less if married.
- You are enrolled in a Medicare Part D drug plan. A Medicare Advantage plan counts if it includes drug coverage.
How to Apply
Call the EPIC Helpline at 1-800-332-3742 (TTY 1-800-290-9138) to ask for an application or to check which plan you would fall into. Forms and the full fee and deductible schedules are on the Department of Health site.
Go to EPIC on health.ny.govIf your income is low, check Extra Help as well. Full Extra Help lowers your Part D costs directly and removes the EPIC fee.
Frequently Asked Questions
Who qualifies for EPIC in New York?
New York residents 65 or older with income last year of $75,000 or less if single, or $100,000 or less if married, who are enrolled in a Medicare Part D drug plan.
How much does EPIC cost?
Fee Plan members pay $8 to $300 a year depending on income. Deductible Plan members pay no fee but must spend an EPIC deductible of $530 to $3,215 on drugs before EPIC copays begin. After that, copays are $3, $7, $15 or $20 per drug.
Does EPIC pay my Medicare Part D premium?
For Fee Plan members and for Deductible Plan members with income up to $23,000 single or $29,000 married, EPIC pays the premium up to $58.82 a month in 2026. Members with higher incomes pay their own premium and get a lower EPIC deductible instead.
Does EPIC replace Medicare Part D?
No. EPIC is secondary coverage. You must be enrolled in a Part D drug plan to receive EPIC benefits, and your Part D plan pays first.
Does EPIC cover drugs my Part D plan does not?
EPIC covers many drugs that Part D plans exclude. You pay the regular EPIC copay for them.
Source: New York State Department of Health, EPIC 2026 Program Highlights (dated August 2025), checked October 11, 2026. The fees, deductibles and premium amount change each year. Confirm your own figures with the EPIC Helpline before you rely on them. This site is not affiliated with the State of New York.