CommercialAdministrativeHigh impact
New Specialty Pharmacy Requirement in Effect for EmblemHealth
EmblemHealth·Pharmacy
Effective date
Jul 14, 2025
We identified it
Jun 20, 2026
Summary
EmblemHealth now requires participating outpatient providers to obtain certain specialty drugs from specific designated specialty pharmacies. This applies to all outpatient settings including physician offices, hospitals, ambulatory infusion centers, and member homes, but does not affect ConnectiCare members.
Action Required
By July 14, 2025: All outpatient providers must review the EmblemHealth Specialty Pharmacy Requirements Drug List Policy to identify affected drugs and required specialty pharmacies. Update ordering and dispensing workflows to ensure specialty drugs are obtained only from designated pharmacies. Train clinical staff on new requirements. Claims for affected drugs obtained from non-designated pharmacies may be denied.