Limits cost-sharing responsibilities of participants in the elderly pharmaceutical insurance coverage program

BILL NUMBER:S1298

Title of bill

An act to amend the elder law, in relation to limiting the cost-sharing responsibilities of eligible participants in the elderly pharmaceutical insurance coverage program

Purpose of the bill

Caps the out-of-pocket expenses (COPE) of an individual participant in either the Fee Plan or the Deductible Plan of the Elderly Pharmaceutical. Insurance Coverage Program (EPIC) at five percent (5%) of annual gross income.

Summary of provisions

Section 247 of the elder law is amended to add new subdivision 5 to read:

5. Cost-sharing responsibilities limit. At no time during a coverage period shall the cost-sharing responsibilities, which are comprised of the sum of the annual registration fee and co-payments, exceed five percent of the eligible program participant's gross income, effective immediately.

Justification

The cost of prescription drugs for senior citizens is a well-documented issue that looms over the political landscape in New York and throughout the country. As drug prices continue to rise, there is an ever-increasing burden on senior incomes. Federal Medicare HMO's continue to dump seniors.

In New York, the Elderly Pharmaceutical Insurance Coverage (EPIC) Plan has picked up some of the burden. EPIC requires that participants pay a variety of premiums, fees, co-pays and deductibles. This currently ranges from 4 to 7 percent of their incomes. COPE ensures that no one will pay more than 5 percent of their income. This will save seniors as much as $170 million. COPE will pick up the cost, pointing to a renewed urgency for Congress to resolve the issue in order to offset the States commitment.

Fiscal implications

To be determined.

Legislative history

This bill has previously been introduced.

Effective date

This act shall take effect on the 120th day next succeeding the date on which it shall have become a law.