Medicaid Managed care pharmacy benefit includes:
- Prescription drugs
- Over-the-counter medicines (OTC)
- Insulin and diabetic supplies
- Smoking cessation agents, including OTC products
- Hearing aid batteries
- Enteral formula
- Emergency Contraception (six per calendar year)
- Medical and surgical supplies
We cover pharmacy benefit services for all our Medicaid managed care members. You must use our network pharmacies to fill all of your prescriptions and any covered over-the-counter medications, diabetic supplies, select durable medical equipment and medical supplies.
We offer a large network of well-known pharmacies, as well as many independent pharmacies. Ask your pharmacy if they are a network pharmacy. If they are, you can continue to use that pharmacy. If not, you will need to switch to a pharmacy that is in our network. This is easy to do; and it's important for getting your prescriptions filled in a timely manner and for avoiding out-of-pocket costs.
Please make sure to use your member ID Card when filling a prescription or obtaining other covered pharmacy benefits at a network pharmacy. It has information that your pharmacy needs to process your prescriptions.
Find a participating pharmacy.
Our drug formulary
Our formulary is a list of medications that network doctors and other medical experts have approved for treating disease and maintaining the health of our Medicaid members. The main purpose of the formulary is to support the use of safe, effective and affordable drugs and treatments while providing our Medicaid members with quality care. Your doctors will prescribe medications listed on the formulary for your benefit plan unless there is a medical need to prescribe a drug that is not on the list
See the list of drugs covered for Medicaid.
Home delivery of a new prescription
You may get home delivery of your maintenance drugs through our mail order pharmacy partner Express Scripts, Inc. (ESI). Maintenance drugs are used to treat chronic conditions and are usually prescribed in quantities greater than 30-day supplies. All you need to do is get a new written prescription from your doctor or other licensed health care provider and mail it to ESI along with the completed order form. You may request an ESI order form to be mailed to you by calling our Pharmacy Customer Service at 1-888-447-7364. Mail the form and the original prescription(s) along with the required copayment to ESI as directed on the form. You may include multiple new prescriptions in your order.
If you prefer, your doctor or other licensed health care professional can assist you. You can bring your order form to them and they can fax it to ESI directly with your prescription. Or they can submit your prescription via the Web. In both cases, they must have your member ID number. Only doctors or other licensed health care providers may submit new prescriptions via fax or Web.
To use the Home Delivery tool, go to myEmblemHealth and register if you haven't already. After you sign in, click on “Pharmacy Services” and then select “Home Delivery”. You will be able to do things like check order status and request refills to existing prescriptions. You will need to register the first time you use the tool, and you will need your member ID to create an account. You or your doctor will still need to send ESI the actual written prescription when using the online option. Please allow 7 to 10 days for delivery from the day ESI receives the prescription(s) to receive your home delivery.
Check on the status of a home delivery prescription order
You can easily check the status of your order via the EmblemHealth/Express Scripts pharmacy benefits tool on this page. You will need to sign in using your member ID and password. You can also call ESI at1-877-866-4165. If you have a hearing or speech impairment, and use a TDD, you can call 1-800-899-2114. You will need your member ID number and your prescription number(s) to access this information.
Specialty drugs are usually injectable, oral or inhaled drugs. They are used to treat chronic conditions such as multiple sclerosis, growth deficiencies, hepatitis C and cancer. They also require special storage and/or handling. You have the choice of filling your specialty drug prescription using one of the following options:
If you choose to use our Specialty Pharmacy Program, your doctor or other health care professional will contact our Specialty Pharmacy Program and your prescriptions will be filled and sent directly to your home or doctor's office. For more information regarding how to use our Specialty Pharmacy Program call EmblemHealth's Specialty Pharmacy Program at1-888-447-0295.
To view a list of retail pharmacies that participate in our specialty pharmacy network, click here.