CommercialAdministrativeHigh impact
New Specialty Pharmacy Requirement Starts July 14
EmblemHealth·Pharmacy
Effective date
Jul 14, 2025
We identified it
Jun 20, 2026
Summary
Starting July 14, 2025, EmblemHealth providers must obtain certain drugs from specific specialty pharmacies designated in their Specialty Pharmacy Requirements Drug List Policy. This requirement applies to all outpatient settings including physician offices, hospitals, member homes, and infusion centers, but excludes ConnectiCare members.
Action Required
By July 14, 2025: Billing team and providers must review EmblemHealth's Specialty Pharmacy Requirements Drug List Policy to identify which drugs require specific specialty pharmacy sourcing. Update drug ordering protocols and vendor relationships to ensure compliance with designated specialty pharmacies. Verify patient insurance type to exclude ConnectiCare members from this requirement. Claims may be denied if drugs are not obtained from required specialty pharmacies.