MedicaidAdministrativeMedium impact
Medicaid Pharmacy Benefit Transition
EmblemHealth·NY·Pharmacy
Effective date
Apr 1, 2023
We identified it
Jun 20, 2026
Summary
Starting April 1, 2023, EmblemHealth's Enhanced Care (Medicaid) and Enhanced Care Plus (HARP) members will have their pharmacy benefits transferred from EmblemHealth to NYRx, the New York State Medicaid Pharmacy program. This affects where pharmacy claims are processed and potentially changes prior authorization requirements for medications.
Action Required
Before April 1, 2023: Billing team must update pharmacy benefit information for EmblemHealth Enhanced Care (Medicaid) and Enhanced Care Plus (HARP) members to reflect transition to NYRx program. Review October 2022 Special Edition of Medicaid Update for specific transition requirements. Update patient eligibility verification processes to check NYRx for pharmacy benefits instead of EmblemHealth.