Formulary

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.

  • 2022 EmblemHealth Medicare Part D Step Therapy

  • 2022 EmblemHealth Medicare Part B Step Therapy

  • 2022 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.