CommercialCoverageMedium impact
2022 EmblemHealth Formulary Changes
EmblemHealth·Pharmacy
Effective date
Jan 1, 2022
We identified it
Jun 20, 2026
Summary
EmblemHealth updated their drug formulary effective January 1, 2022, which may affect prescription coverage for patients. Some medications may no longer be covered or may require prior authorization, and affected members have been notified separately.
Action Required
Immediately: Billing team should verify current formulary status for EmblemHealth patients when prescriptions are denied or require prior authorization. Coordinate with providers on medication changes as needed. Monitor for increased prior authorization requests for pharmacy claims.