Notification: Pharmacy Utilization Management Services Starting Aug 3, 2020

Starting Aug. 3, 2020, Express Scripts (ESI) will perform utilization management services for most drugs. The services include preauthorization, quantity limits, and step therapy for all Commercial and Health Exchange EmblemHealth plan members.

We encourage you to take advantage of ESI’s Electronic Prior Authorization (ePA) option. ePA is fast, secure, and simple. Any authorized personnel, including nurses and office staff, can use your electronic health record (EHR) or sign in to an online portal. You save time, and patients get their medications faster.

You can also utilize the below phone and fax numbers starting Aug. 3 for preauthorization requests:

  • Pharmacy Drug Reviews: call 844-516-3324, 24/7/365 or fax to 877-251-5896
  • Medical Drug Reviews: call 877-681-9866, 8 a.m. to 7 p.m., Monday through Friday or fax to 
    866-896-1209

Preauthorization for drugs and supportive agents, for Commercial and Health Exchange members, issued by EmblemHealth before Aug. 3, 2020 are effective until the preauthorization end date. Subsequent preauthorization requests must be submitted to ESI.

These services will not apply to Medicare and Medicaid pharmacy utilization management requests or adult chemotherapy and supportive agents. EmblemHealth will continue utilization management review for these members. Continue sending preauthorization requests for these members by phone or fax to:

  • Specialty Drugs: call 888-447-0295, 8 a.m. to 6 p.m., Monday to Friday or fax to 877-243-4812
  • Pharmacy Drugs: call 877-362-5670, 8 a.m. to 6 p.m., Monday to Friday or fax to 877-300-9695

This move is part of EmblemHealth’s continuing transformation and desire to partner with our providers on delivering care to our members. If you have any questions, call EmblemHealth Provider Services at 
866-447-9717. Our hours are 8 a.m. to 6 p.m., Monday to Friday. A representative will be happy to help.

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