Formulary

List of Covered Drugs

  • 2024 EmblemHealth HMO and D-SNP Drug Formulary

  • 2024 Recent Changes to EmblemHealth's HMO and D-SNP Drug Formulary

  • 2024 Recent Changes to EmblemHealth's City of New York Drug Formulary

 

Employer Group Formulary

List of Covered Drugs

  • 2024 City of New York PDP Drug Formulary

  • 2024 HMO Employer Group 4 Tier Drug Formulary

  • 2024 HMO and PPO Employer Group 5 Tier Drug 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.

  • 2024 EmblemHealth Medicare Part D Prior Authorization

  • 2024 City of New York Prior Authorization Criteria

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.

  • 2024 EmblemHealth Medicare Part D Step Therapy

  • 2024 EmblemHealth Medicare Part B Step Therapy

  • 2024 City of New York Step Therapy Criteria

    The drugs on this list require step therapy pre-approval. This means that your doctor must have you first try a different drug to treat your medical condition before we will cover a drug that needs step therapy pre-approval.