CommercialPrior AuthHigh impact
Reminder: Cancer Drug Preauthorization List Expands in August
EmblemHealth·Oncology, Hematology·Prior Authorization
Effective date
Aug 15, 2021
We identified it
Jun 20, 2026
Summary
Starting August 15, 2021, EmblemHealth and ConnectiCare expanded their prior authorization requirements to include more oncology-related chemotherapy drugs and supportive agents delivered in physician offices, outpatient hospitals, and ambulatory settings. Providers must now obtain preauthorization for these additional cancer medications before administration.
Action Required
By August 15, 2021: Billing team must identify all oncology patients receiving chemotherapy drugs and supportive agents in office or outpatient settings. Review EmblemHealth's FAQ and ConnectiCare's Pharmacy Policies to determine preauthorization requirements and submission processes. Update workflow to obtain prior authorization before drug administration. Claims will be denied without proper preauthorization.