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Elderly Pharmaceutical Insurance Coverage (EPIC) [1] [2] [3] ("New York State's Senior Prescription Plan") [4] was designed so that personal/out-of-pocket costs for medicines are reduced or largely paid for program participants by the state. [1] Members are also given assistance with Medicare Part D. [5]
By the end of the century, less than one-third of drug spending was paid out-of-pocket. Despite the absence of a Medicare drug benefit, about 70% of Medicare enrollees obtained drug coverage through other means, often through an employer or Medicaid. [36] Medicare began offering subsidized outpatient drug coverage in the mid-2000s.
The benefit is funded in a complex way, reflecting diverse priorities of lobbyists and constituencies. It provides a subsidy for large employers to discourage them from eliminating private prescription coverage to retired workers (a key AARP goal); It prohibits the federal government from negotiating discounts with drug companies;
Provincial and territorial government provide partial prescription drug coverage and the overall drug payment is a mix of public taxation, private insurance and out-of-pocket expenses. [4] [6] Insurance coverage differs regionally, although each public drug coverage plan must meet standards set by the federal government. [6]
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