Effective July 14, 2025, EmblemHealth participating outpatient providers — outpatient hospitals, physician offices, member homes, and ambulatory infusion centers — will be required to obtain certain drugs from specific specialty pharmacies.
The specialty pharmacy will bill EmblemHealth directly for the drug under the member's medical benefit. Outpatient providers may only seek reimbursement for administering the medication. Additionally, outpatient providers may not bill the member for the medication. The Specialty Pharmacy Requirements Drug List Policy excludes Home Infusion providers. The policy lists the applicable drugs and pharmacies you will need to use. This policy does not apply to ConnectiCare.
JP 68975 04/2025
