Emergency Prescription Assistance Program (EPAP)

Important Information for Patients

Easy steps to enroll in EPAP services:

Step 1: Make sure that EPAP has been activated in your area

EPAP claims can only be filed in a federally designated disaster area. To find out whether EPAP has been activated in your area, check the EPAP Status. Please note that EPAP-active areas may change.

Step 2: Find out if you are eligible

EPAP is for people who do not have health insurance. If you have health insurance, such as an individual health insurance policy or employer-sponsored coverage, or public insurance, such as Medicare, Medicaid, or other third party coverage, you are not eligible to use EPAP. Call the EPAP Hotline at 1-855-793-7470 to find out if you are eligible and to register with EPAP.

Step 3: Find out if your prescription items are covered

EPAP covers most prescription drugs, vaccinations, certain medical supplies, and some forms of medical equipment, including canes, walkers, wheelchairs, and crutches (also known as durable medical equipment). You can call Express Scripts at 1-855-793-7470 or check the list of items covered by EPAP to learn if your prescription, medical supplies, or medical equipment are covered. Pharmacies must dispense the generic form of a medication unless indicated as Brand Medically Necessary (BMN) or Dispense as Written (DAW) by your licensed health care practitioner.

Step 4: Locate an enrolled pharmacy

Claims can only be processed by a pharmacy that is enrolled in EPAP. Find EPAP-enrolled pharmacies near you.

Step 5: Provide the pharmacy with your prescription information

To receive prescription drugs, you must have at least ONE of the following.

1. a new, written prescription from a licensed health care practitioner;
2. a current prescription bottle;
3. a prescription phoned in or electronically transmitted by a licensed health care practitioner; or
4. proof of an existing prescription.

If you need replacement durable medical equipment, medical supplies, or vaccinations that do not usually require a prescription, ask your healthcare provider to contact the pharmacy.

If you have questions about using EPAP during a disaster, call the EPAP Hotline at 1-855-793-7470.

Important Information for Pharmacies

How do pharmacies use the Emergency Prescription Assistance Program?

Before a Disaster: Enroll your pharmacy

By planning now, you can prepare to help uninsured people in your community stay healthy when disaster strikes. Pharmacies must be registered with Express Scripts to process claims under EPAP. If you are not already registered, visit the Express Scripts website to register.

Not sure if your pharmacy has enrolled? Search the list of EPAP-enrolled pharmacies to find out.

During and After a Disaster: Processing claims under EPAP

Once your pharmacy is enrolled in EPAP, you must ensure that all of the following criteria are met before providing assistance:

1. Confirm that EPAP has been activated in your patient's area: EPAP claims can only be filed for patients who live in a federally designated disaster area. Your pharmacy does not have to be located in the federally designated area in order to process a claim under EPAP. To find out whether EPAP has been activated in your patient’s area, check the EPAP Status.
2. Assist patients with eligibility and registration: EPAP coverage only extends to uninsured patients. Patients that have health insurance, such as an individual health insurance policy or employer-sponsored coverage; public insurance, such as Medicare or Medicaid; or other third party coverage, are not eligible to receive assistance under EPAP. If a patient says they are eligible but they have not confirmed their eligibility or registered with EPAP, tell them to call the EPAP Hotline at 1-855-793-7470. If they cannot call, you may call on their behalf if they are willing to provide you with the necessary information.
3. Check for a valid prescription: Eligible patients must provide ONE of the following: 1) a new, written prescription from a licensed health care practitioner; 2) a current prescription bottle; 3) a prescription phoned in or electronically transmitted by a licensed health care practitioner; or 4) proof of an existing prescription. If patients need replacement durable medical equipment (DME), medical supplies, or vaccines that do not usually require a prescription, contact the patient’s healthcare provider.
4. Ensure that the prescription and/or DME is covered under EPAP: EPAP only covers certain prescription medications and DME. To find out whether the patient’s medication and/or DME is covered, please see Items Covered by EPAP. Enrolled pharmacies must dispense the generic form of a medication unless indicated as Brand Medically Necessary (BMN) or Dispense as Written (DAW) by the licensed health care practitioner.
5. Provide a 30 day supply of prescription drugs: Patients can receive an initial 30-day supply of most prescription drugs or specific medical supplies under EPAP. Prescriptions can be renewed every 30 days for as long as EPAP is active. If patients rely on medical supplies, they can get additional supplies every 30 days for as long as EPAP is active. DME is typically only provided once, but if it is lost or stolen after it has been issued, it may be replaced. Vaccinations are typically a single course of treatment and do not need to be refilled.

Questions?

If you have questions, call Express Scripts at 800-282-2881.

What is EPAP?

The Emergency Prescription Assistance Program (EPAP) helps people in a disaster who don’t have health insurance providing access to:

• Prescription medicine
• Medical equipment
• Medical Supplies
• Vaccinations

Who can receive benefits under the EPAP?

People without health insurance who qualify for EPAP.

EPAP allows enrolled pharmacies to process claims for eligible people who live in a federally identified disaster area.

People who qualify for EPAP can replace certain prescription medicine, medical supplies, vaccines and certain pieces of medical equipment that were:

• Lost or damaged while evacuating or because of the disaster
• Not refilled before disaster
• Lost or damaged at evacuation shelter
  

Prescriptions for medications and medical supplies may be renewed every 30 days for as long as the EPAP is active.

Who doesn’t qualify for EPAP?

You do not qulify if you have:

• Individual health insurance policy
• Employer-sponsored coverage
• Medicare
• Medicaid
• Other third party coverage

Click here for more information on EPAP