Sign Up to Participate in the NY Prescription Saver Card Program

The NYS DOH is requesting that pharmacies enroll in the NY Prescription Saver Card, the recently approved State-sponsored drug discount card. This program is designed to help uninsured, lower income, disabled and near elderly individuals, who are not eligible for Medicaid or EPIC, afford prescription medications they need. Discounts obtained by the State from participating pharmacies and manufacturers will be passed through to the cardholder at the point-of-sale. While the discount card does not provide insurance coverage, the lower pharmacy prices combined with manufacturer discounts will certainly help make prescription drugs more affordable.

Click Here for the link to have your Customers/Patients sign up in the program.

Click here for the Pharmacy/Pharmacist sign up & the Letter from the DOH including the 4-page Pharmacy Agreement & FAQ's (faq's can also be found below)

New York Prescription Saver Card - Frequently Asked Questions: Pharmacists

1. Who is eligible for the NY Prescription Saver Card?
The new discount card is for New York State residents who are age 50-64, or Social Security disabled, and have an annual household income up to $35,000 for singles and up to $50,000 for married couples and are NOT receiving Medicaid benefits.

2. Is there is an enrollment or application fee?
No, there is no enrollment or application fee to join the New York Prescription Saver Card.

3. What drugs are covered? Are diabetic supplies included?
The discount card covers the same drugs that are covered by the Elderly Pharmaceutical Insurance Coverage (EPIC) program. This includes all prescription drugs plus insulin and insulin syringes and needles. (Test strips and glucose monitors are not covered.)

4. Can the NY Prescription Saver Card be used with other drug coverage or discount cards?
No. The member can have other drug discount cards or coverage along with the New York Prescription Saver card, but only one card can be used for each purchase.

5. Can individuals on Medicaid use the NY Prescription Saver Card?
No. Medicaid recipients are not eligible because New York's Medicaid program provides more comprehensive coverage of prescriptions and some over-the-counter medications.

6. If the card member has Medicare Part D or other insurance, can the new discount card be used for drugs not covered by the plan? How about for the deductible and "doughnut hole"?
If the member is under age 65 and has Medicare Part D, they may use the discount card instead of their Part D plan, but they cannot use the discount card and another insurance card for the same purchase.

If the member has Medicare Part D and is in their deductible or "doughnut hole," they can use the NY Prescription Saver Card instead of their Part D card to get the discount on their purchases. According to Medicare, they can get credit for these purchases toward their deductible or out-of-pocket limit by sending in the paper receipt to their Part D plan; the pharmacy cannot bill the plan directly.

7. Can EPIC enrollees use the NY Prescription Saver Card while they are in the deductible or doughnut hole status, or for drugs that are not on their Medicare Part D plan formulary?
Generally, EPIC enrollees will not be eligible for the NY Prescription Saver Card. The card is for those under 65 or disabled, while EPIC is for those 65 or older. In limited situations, a Social Security disabled individual may be over 65 and qualify for EPIC. If so, they can use the card instead of their Part D or EPIC coverage, but not on the same prescription purchase.

8. Can the NY Prescription Saver Card be used to help pay for Medicaid spend down purchases?
No. If an individual is enrolled in Medicaid, even for spend down, they are not eligible for the discount card.

9. Is the State using a pharmacy benefit manager to operate the card?
No, the EPIC staff and a contractor will be operating the new discount card program.

10. What payment rate will be provided to participating pharmacies?
Purchases under the Prescription Saver Card will be subject to the same pricing requirements as for the EPIC program.

11. How timely will payment be under the Prescription Saver Card?
Payments to pharmacies will be released via electronic transfer within two business days of the claim transaction.

12. What about manufacturer discounts, how will those be handled?
When manufacturers agree to participate in the NY Prescription Saver Card by providing discounts for their products, the amount of that discount will be included in the online claim response to the pharmacy. The online claim system will indicate how much is to be collected from the cardholder and how much the State will reimburse the pharmacy (i.e. the manufacturer discount amount). The cardholder and State payments, combined, will equal the allowed pharmacy price.

13. Will there be manufacturer discounts on all prescriptions?
No, manufacturer participation in the NY Prescription Saver Card is voluntary and some may choose not to participate.

14. Can pharmacists enroll disabled and near elderly individuals into the program?
Applications may be taken over the phone, as well as by mail and via an electronic website. Pharmacists are encouraged to assist customers to complete an application if possible. Enrollment details will be available in early 2009.