🏥 Anthem Blue Cross Grandfathered Brand-Name Rx Settlement

The settlement addresses allegations that Anthem denied coverage for medically necessary brand-name (single-source) prescription drugs and applied an $8,850 brand-name-drug deductible on certain grandfathered California health plans.

People on an Anthem Core 5000, Tonik DN14, Tonik DN15, or RightPlan (with generic Rx coverage) plan who paid out of pocket between January 1, 2017 and May 8, 2026 for a brand-name single-source drug that would otherwise have been covered.

varies (reimbursement of documented out-of-pocket brand-name drug costs; plus an automatic refund of the $8,850 deductible for members who were charged it)

2026-11-10

The settlement resolves matters between Anthem and the California Department of Insurance over Anthem's denial of coverage for brand-name single-source drugs and its application of a brand-name-drug deductible on grandfathered plans. Members who paid out of pocket for an eligible brand-name drug can file a claim with supporting documentation for reimbursement, while members who were charged the $8,850 deductible receive an automatic refund without filing. The claims process is run by Rust Consulting, which mailed the notice and claim-form package to class members on May 8, 2026. Claim forms and documentation must be postmarked no later than November 10, 2026.