Discover the New Features of Our Improved Provider Manual

GHI HMO Plans Now Underwritten By HIP

State Sponsored Programs Rebranded

Changes to Medicare PPO Prior Approval Rules for PT/OT/ST

Medicaid Redesign Team Updates

Claims Corner

Behind the Scenes

Case Management Programs

EmblemHealth Pharmaceutical Management Program

Changes to Provider Attestation Form Submission

High Risk Medications for Elderly Patients

Do You Make Snap Decisions?

Does Your Office Have a Flu Immunization Champion?

Serology Testing Inappropriate for Detection of Active H. pylori Infection

Correct Billing for Mammography Services

CPT Codes for Tobacco Cessation Counseling

Healthy Beginnings PATH

Clinical Corner

News&Notes Archive


Review your information now to ensure you are correctly listed in our EmblemHealth directories. If any of your information has changed or is inaccurate, just follow our simple instructions to update your profile online. Can't update your information online? Fax your changes to our Provider Modifications team at 1-877-889-9061.

EmblemHealth Pharmaceutical
Management Program

You will find the most up-to-date information about pharmaceutical management procedures and formularies on our EmblemHealth Web site, including:

  • Pharmacy benefit designs
  • Formulary changes
  • Prior authorization criteria
  • Procedures for generic substitution, therapeutic interchange, step therapy or other management methods to which the practitioner’s prescribing decisions are subject
  • Any other requirements, restrictions, limitations or incentives that apply to the use of certain pharmaceuticals

You can access the Pharmacy Services, Injectables and Specialty Pharmacy Program chapters of the Provider Manual for more information about pharmacy benefits. Go to the Web page to review the Injectable Drug Utilization Management Program. We will also notify you about these updates and other important information through available communication channels, including:

The formularies for all our plans are posted on our Pharmacy Web page. We also have online Formulary Search tools available for our Medicare, Commercial and Medicaid/FHPlus plans. You may access important forms online, including:

For the latest updates to our Commercial and Medicare formularies, please go to the Formulary Updates on Clinical Corner. Should you have any questions regarding our pharmaceutical management procedures, please contact EmblemHealth’s Clinical Pharmacy Services at 1-877-444-3657. For information on specialty medications, please call the Specialty Pharmacy department at 1-888-447-0295.


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