All PlansPrior AuthMedium impact
Updated Preauthorization Lists
EmblemHealth·Pharmacy·Prior Authorization
Effective date
Aug 13, 2026
We identified it
Jul 17, 2026
Summary
EmblemHealth has updated its Preauthorization Lists effective August 13, 2026. The policy references a Pharmacy Preauthorization List (JP71452, dated 05/2026) and notes no new quarterly AMA/CMS code updates for April. Billing teams must consult the revision history for specific updates and effective dates on the referenced preauthorization list.
Action Required
By August 13, 2026: Billing team must access the full Pharmacy Preauthorization List (JP71452) and revision history at https://www.emblemhealth.com/providers/news/updated-preauthorization-lists-202605 to identify which specific pharmacy codes and services now require prior authorization. Update billing system rules and prior authorization workflows to reflect any newly added pharmacy services. Verify that all pharmacy claims for EmblemHealth plans are screened against the updated preauthorization requirements before submission. Failure to obtain required prior authorization will result in claim denials.