Anthem Grandfathered Rx Settlement — Reimbursement for Denied Brand-Name Prescription Drugs

The California Department of Insurance alleged that Anthem Blue Cross Life and Health Insurance Company failed to cover medically necessary brand-name (single source) prescription drugs as required by California law for certain grandfathered health plans, and that it charged some members an $8,850 deductible for those drugs. Anthem entered a Special Notice of Defense to resolve the matter. Without admitting wrongdoing, Anthem agreed to pay a $750,000 penalty, reimburse eligible policyholders for out-of-pocket costs they paid for denied brand-name drugs, and automatically refund the $8,850 deductible amounts some members were charged.

You may be eligible if you, or someone covered under your Anthem Core 5000, Tonik DN14, Tonik DN15, or RightPlan (with generic prescription drug coverage) policy, paid out of pocket for a brand-name (single source) prescription drug between January 1, 2017 and May 8, 2026; the drug would otherwise have been covered under the plan but was denied solely because it was a brand-name (single source) product; and you were not already reimbursed for that cost by another health plan or third party.

Every claim must include three things: proof of the prescription (a copy of the prescription or written verification from the prescribing provider or dispensing pharmacy); proof of payment showing you personally paid out of pocket (a pharmacy receipt, credit card statement, or cancelled check); and a signed affidavit confirming the drug was purchased and paid for out of pocket and not reimbursed by another plan or party. To file online you also need the Claimant ID and Access Code printed in the upper right of page 1 of your mailed Claim Form. Each person must submit a separate Claim Form; family members cannot combine claims.

If you were required to pay all or part of the $8,850 deductible for coverage of brand-name prescription drugs under one of the affected plans, Anthem refunds that amount automatically. No claim form is required for the deductible refund. Anthem issued these refund checks to the address on file on or around May 22, 2026. If you believe you paid the deductible but did not receive a refund, you can follow up through the contact page on the official settlement website.

Completed Claim Forms and all supporting documentation must be uploaded, emailed, or postmarked by November 10, 2026. Within 45 days of receiving your claim, Anthem will either determine your eligibility or notify you of a denial and the reasons for it. If you are found eligible, your reimbursement is paid by check mailed to the policyholder's address on file within 60 days of the date your complete claim is received. If a claim is incomplete, you get one opportunity to submit supplemental information; there is no right to appeal a denial.