Covered Drugs

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 our EmblemHealth VIP (HMO) Medicare comprehensive formulary.

This list includes both generic and brand name drugs, and they are listed in levels or “tiers”, based on cost. The lower the level or tier, the lower your cost for the drug will be.

Document Download (PDF)
2019 EmblemHealth HMO Drug Formulary - Comprehensive list of covered drugs
2019 Recent Changes to EmblemHealth's HMO Drug Formulary Coming Soon
2018 EmblemHealth HMO Drug Formulary - Comprehensive list of covered drugs
2018 Recent Changes to EmblemHealth's HMO Drug Formulary Download (PDF)

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.

Document Download (PDF)
2019 EmblemHealth Medicare Part D Prior Authorization (HMO) Coming Soon
2018 EmblemHealth Medicare Part D Prior Authorization (HMO) Download (PDF)

For your convenience, you can go to PromptPA- Prior Authorization Portal for Medicare, which lets you and your health care professionals 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 you may need to try a different or more common drug first. Below is a list of drugs that require Step Therapy.

Document Download (PDF)
2019 EmblemHealth Medicare Part D Step Therapy Coming Soon
2018 EmblemHealth Medicare Part D Step Therapy Download (PDF)

For more information view our Transition Policy, Medication Safety and Quality Assurance Policy.


Disclaimer

In general, beneficiaries must use network pharmacies to access their prescription drug benefit, except in non-routine circumstances.

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