Medicare AdvantageAdministrativeMedium impact
Lowering Medication Costs for Our Medicare Members
EmblemHealth·Pharmacy
Effective date
Aug 18, 2025
We identified it
Jun 20, 2026
Summary
Starting August 18, 2025, EmblemHealth will fax providers cost-saving prescription alternatives for Medicare members. Providers must complete and return authorization forms to approve or decline the recommended medication changes.
Action Required
By August 18, 2025: Providers must establish workflow to review and respond to EmblemHealth faxed medication cost-saving recommendations for Medicare members. Staff should monitor for incoming fax forms, ensure providers review recommendations promptly, and return completed authorization forms via fax. For controlled substances, providers must BOTH fax the authorization form AND send prescription changes electronically to the member's pharmacy through the EHR.