Medicare Formularies

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At EmblemHealth, we offer Medicare plans that cover a wide range of prescription drugs. Below is a complete list of all covered drugs in our comprehensive formularies. 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.



List of Covered Drugs


Employer Group Formulary

List of Covered Drugs


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 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.

  • 2021 EmblemHealth Medicare Part D Step Therapy

  • 2021 EmblemHealth Medicare Part B Step Therapy

  • 2021 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.

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your prescriptions

Delivery and Refills

Find out how to set up home delivery or get a prescription refill.

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MTM Program

Medication Therapy Management

Find out if you qualify for this service, which is free for EmblemHealth Medicare plan members with Part D prescription drug coverage.

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

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Medicare Pharmacy

Additional Pharmacy Information

Learn more about what our over-the-counter debit benefit covers, how to get money back for a drug and more.

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Last Updated 01/01/2021

Y0026_ 200570 Accepted 9/29/20