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HMO Formularies

At EmblemHealth, we offer Medicare plans that cover a wide range of prescription drugs. For your convenience, there is a complete list of all covered drugs in the plan (a comprehensive formulary). In addition, there is a brief summary of only the preferred generic and preferred brand drugs in the plan. Please also note that any recent changes will be available for download below, along with your plan’s comprehensive formulary.

Prior Authorization

Prior Authorization means that you will need to get approval from your plan before you fill your prescriptions. If you do not get an approval, your plan may not cover the drug. Below is a list of drugs that require prior-authorization.

For your convenience, you can go to PromptPA- Prior Authorization Portal for Medicare, which lets you and your health care providers submit Prior Approval/Coverage Determination requests online for your prescription drugs. You can also see the status of your requests. It’s easy to get started, go to “Member” on PromptPA and follow the directions.

In addition, you can request prior approval by completing a Coverage Determination Form or by calling Customer Service.

Step Therapy

Step Therapy means that in some cases your doctor must have you first try certain prescription drugs to treat your medical condition before we will cover a different drug.

Please also see our Additional Forms and Resources section on our Additional Pharmacy Information page that can provide more information on our Transition Policy, Medication Safety and Quality Assurance Policy.

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