Bill > A08226

This bill expands and clarifies the eligibility requirements for the Elderly Pharmaceutical Insurance Coverage (EPIC) program by allowing participants to enroll in health plans that meet or exceed Medicare Part D standards, not just Medicare Part D itself. The bill requires the New York Department of Health to create a process for insurers and individuals to have their prescription drug coverage evaluated and compared to Medicare Part D's standard of coverage. Specifically, insurers can voluntarily submit their health plans for assessment, and individuals can request an evaluation of their health plan's prescription drug coverage. The department will conduct comprehensive actuarial analyses to determine if these plans meet or exceed the Medicare Part D standard, and will maintain an online list of qualifying health plans. The bill also defines key terms like "CMS" (Centers for Medicare & Medicaid Services) and establishes detailed criteria for what constitutes a health plan. For low-income EPIC program participants, the program will continue to help pay for prescription drug plan premiums, and the bill requires the Department of Health to notify all prescription drug insurers in the state about these new provisions. The changes aim to provide more flexibility for seniors in obtaining affordable prescription drug coverage while maintaining rigorous standards of care.

Health and Social Services

https://www.nysenate.gov/legislation/bills/2025/A8226