Emblem’s switch to a new pharmacy benefits manager 

We know there has been some confusion and misinformation circulating about prescription coverage, so we want to take a moment to explain what is — and is not — changing when it comes to getting your prescriptions filled.

EmblemHealth is changing its pharmacy benefit manager from Express Scripts to Prime Therapeutics for all its health plans, but your prescription plan’s copays and benefits will remain the same. If you take any medication through the PICA drug program, nothing is changing, and you will continue to fill those prescriptions the same way.

The only real change is that if you have chosen to use mail-order delivery for 90‑day supplies of medication, you will now use Amazon Pharmacy instead of Express Scripts home delivery.

For a more detailed explanation of the change, read the Q&A below or watch this online version of the presentation that was given at last Thursday’s RTC membership meeting. 

What is a pharmacy benefits manager? 

A pharmacy benefit manager, or PBM, helps employers manage drug costs and coverage. It negotiates prices with drugmakers and works with pharmacies to process prescriptions. Pharmacy benefit managers do most of their work on the “back end” of your drug plan, meaning you rarely interact with them. 

What does this change mean for UFT retirees? 

If you have an optional prescription rider through GHI Senior Care, HIP VIP, HIP HMO or the NYCE PPO plan, your pharmacy benefit manager will be Prime Therapeutics starting on Jan. 1, 2026, and all your current prescriptions under Express Scripts will be automatically rolled over to Prime Therapeutics for you. 

What about prior authorizations for prescriptions? 

Prior authorizations are given for only a certain length of time (usually six months or a year). Once they expire, they must be renewed by your doctor and your prescription plan. Many prior authorizations are given for a calendar year and therefore expire on Jan. 1, so they would need to be renewed even if there were no change to the pharmacy benefit manager. 

If you received a letter saying you need a new prior authorization, but your current prescription has NOT expired, EmblemHealth is aware of the problem and will send a correction letter. 

Current prior authorizations: 

• If you currently have a prior authorization that extends into 2026, it will be automatically rolled over to Prime Therapeutics.
• There is no need for you to do anything until your existing prior authorization date is up. 

New prior authorizations: 

• Prescription drugs requiring prior authorization between now and the end of December will still go through Express Scripts. The process will remain the same. If authorization is granted, these prescriptions will be automatically transferred to Prime Therapeutics on Jan. 1, 2026.
• If you start a new medication in 2026 that requires prior authorization, your doctor will request a prior authorization from Prime Therapeutics. The process will be similar to the process of requesting prior authorization through Express Scripts. 

How do I get my prescriptions under Prime Therapeutics? 

Retail: 

• Your retail pharmacy options remain the same. You will still be able to pick up your prescriptions, including 30-day supplies of acute medication prescriptions and 90-day supplies of maintenance medications, at retail pharmacy networks.
• Bring your NYCE PPO or HIP HMO ID card when picking up your medication.
• In the unlikely case that your current pharmacy is not in Prime Therapeutics’ network, you will receive a letter with instructions for finding a new pharmacy near you. 

Mail Order: 

Medicare retirees will now have two options for mail-order pharmacies: 

• Express Scripts (ESI, same as today): This is the same home delivery service that you have had and no change or action is needed.
• Amazon Pharmacy: If you would like to use Amazon Pharmacy for home delivery instead of Express Scripts, you can create an account or call 844-536-4074. However, there is no need to create an Amazon Pharmacy account to use this service. Your doctor can send your prescriptions to Amazon Pharmacy for you if you request it. 

Pre-Medicare retirees will use Amazon Pharmacy only for mail-order prescriptions: 

• Your prescriptions will be automatically transferred from Express Scripts to Amazon Pharmacy.
• Mail-order prescriptions will be filled by Amazon Pharmacy. Ask your doctor to send any new prescriptions (except PICA medication) that you would like to receive through mail order directly to Amazon Pharmacy.
• There is no need to create an Amazon Pharmacy account to use this service. However, if you would like to manage your mail-order medication online, you can create an Amazon Pharmacy account or call 844-536-4074 . Amazon Pharmacy is different from a regular Amazon account. You do not have to be an Amazon member to create a pharmacy account. If you are an Amazon member, you must go to the pharmacy section to set up your access. Once you create an account, you will be able to see your existing eligible medication. 

See the charts below for a comprehensive look at your health plan’s prescription drug options:

What if I have been notified that I need to change medications?

We estimate that less than 2% of members will have to switch to an alternate medication as a result of this switch in the pharmacy benefit manager. If you are one of those rare cases, follow the instructions from EmblemHealth and Prime Therapeutics to work with your doctor to find a replacement medication that works for you. A call with your doctor should be enough to send a new electronic prescription to your pharmacy.

To ease the transition, Prime Therapeutics will allow a one-time refill of current medications in 2026.

If you have more questions, you can:

• Call EmblemHealth’s pharmacy help desk at 866-799-7919.
• Call Prime Therapeutics at 833-998-5430.
• Call the UFT Welfare Fund at 212‑539‑0500.
• Email the UFT Welfare Fund at rxhelp [at] uftwf [dot] org (rxhelp[at]uftwf[dot]org).
• Call EmblemHealth at the number on the back of your medical ID card..

Please continue to check your postal mail for information from EmblemHealth and Prime Therapeutics.