Eligibility Information Sheet For Emergency Prescription Assistance Program (EPAP)
Eligibility Information Sheet For EPAP (PDF , Pages, 26kb)
Emergency Prescription Assistance Program (EPAP) provides prescription drugs and limited durable medical equipment (DME) to individuals affected by a disaster of national significance with no other health insurance.
- Recipient(s) must demonstrate residence within the covered area. Zip codes of areas determined eligible for EPAP will be posted to this website just prior to or during the activation. Identification can be a driver’s license, state issued identification card, current lease, utility bill, or other credible attestation of residence.
- Recipient enrollment is performed during the real-time pharmacy claim transaction. As such, recipient information required on the transaction includes recipient name, full USPS address, city, state and zip code. Failure to include this information on the transaction may cause the enrollment verification to be rejected and the claim denied. Contact the ACS Customer Care Center for assistance (ACS Care Center Telephone Number: 866.935.4135).
- Recipient with a valid prescription is eligible for a one time fill of up to a 30-day supply for medication to treat an acute condition and chronic illnesses, with standard limitations for controlled substances.
- Replacement of maintenance prescription drugs or medical equipment lost or damaged as a direct result of the declared emergency.
- Formulary follows the Medicare Part D guidelines and designated durable medical equipment and excludes the following regardless of whether covered under Medicare Part D:
- Cosmetic Agents
- Contraceptives
- Fertility Agents
- Erectile Dysfunction
- Weight Loss Medications
- Over-the-Counter (OTC) Medications
- Mandatory Fill for the lowest price alternative between brand and generic, unless prescribed Dispense as Written (DAW) or Brand Medically Necessary (BMN).
- EPAP coverage is only available to individuals who do not have other drug and/or DME coverage; claims submitted will the checked for possible Other Payer coverage. If Other Payer coverage is known, claims are not eligible for payment under EPAP.