Starting Jan. 1, 2026, Prime Therapeutics (Prime) will perform utilization management services for pharmacy and medical pharmacy drugs. The services include preauthorization, quantity limits, step therapy, chemotherapy and supportive agents for all EmblemHealth plan members.
We encourage you to take advantage of Electronic Prior Authorization (ePA) options. ePA is fast, secure, and simple. You can sign up to use the electronic prior authorization (ePA) system through CoverMyMeds®; all you need is a computer and an internet connection.
You may use the following phone and fax numbers starting Jan. 1 for pharmacy drug preauthorization requests:
- Commercial pharmacy drug reviews: Call 866-799-7919 , 24/7/365, or fax to 914-901-3741.
- Medicare pharmacy drug reviews: Call 866-799-7781, 24/7/365, or fax to 914-901-3741.
The Medical Pharmacy Solutions team at Prime Therapeutics will administer the medical pharmacy utilization management program for all EmblemHealth members. This program also replaces the EmblemHealth Oncology Drug Management Program.
Preauthorization will be required for the medical specialty drugs when they are administered in the following places of service (POS):
- Physician office (POS 11).
- Patient home (POS 12).
- Outpatient facility (POS 19, 22).
Beginning Dec. 22, 2025, providers may contact Prime using the information below to obtain preauthorization for select specialty drugs that fall under the medical benefit on or after Jan. 1, 2026. For medical drug reviews from 8 a.m. to 6 p.m., Monday through Friday you may:
- Call 888-656-6671.
- Fax to 833-519-4548.
- Online: gatewaypa.com.
Preauthorization for drugs and supportive agents issued by Express Scripts and Evolent before Dec. 31, 2025, are effective until the preauthorization end date. Subsequent preauthorization requests must be submitted to Prime Therapeutics.
Prime will host web-based training sessions in December. Please choose a session that works best for you and register at one of the links below:
EmblemHealth Medical Pharmacy Preauthorization Program Overview