Medicare AdvantageAdministrativeMedium impact
Welcome to 2026!
EmblemHealth·NY·Provider News
Effective date
Jan 1, 2026
We identified it
Jun 20, 2026
Summary
EmblemHealth has published their 2026 annual provider notice with key updates including a new Pharmacy Benefit Manager (Prime Therapeutics), updated preauthorization lists with notable changes, and guidance for NYCE PPO members. Providers need to review multiple updated resources for the new year.
Action Required
Immediately: Billing team must review the updated Preauthorization List for notable changes and update prior auth requirements in billing system. Update pharmacy benefit manager information to Prime Therapeutics for City of New York members including Senior Care and NYCE PPO. Review the annual provider notice and new benefit plans with no referrals required to update workflow processes.