Anthem Grandfathered Plan Prescription Drug Denials Settlement

People enrolled in certain 'grandfathered' Anthem plans (Core 5000, Tonik DN14, Tonik DN15, RightPlan) who paid out of pocket for a brand-name (single-source) prescription drug between Jan 1, 2017 and May 8, 2026 that was denied solely because it was brand-name. The $8,850 deductible refund is automatic.

• Enrolled in Anthem Core 5000, Tonik DN14, Tonik DN15, or RightPlan
• Paid out of pocket for a brand-name (single-source) drug Jan 1 2017 – May 8 2026, denied solely for being brand-name, and not reimbursed elsewhere
• File with the Claimant ID & Access Code from your mailed Claim Form, plus proof of prescription, proof of payment, and a signed affidavit

The California Department of Insurance alleged that Anthem Blue Cross Life and Health failed to cover medically necessary brand-name (single-source) prescription drugs as required by California law for certain grandfathered individual/family plans (Core 5000, Tonik DN14/DN15, RightPlan), and required some members to pay an $8,850 deductible for those drugs. Anthem entered a Special Notice of Defense (adopted by the Insurance Commissioner effective March 23, 2026) without admitting liability, agreeing to a $750,000 penalty and to reimburse affected policyholders' out-of-pocket costs for those brand-name drugs.

Who's excluded: Out-of-pocket costs reimbursed by any other plan or third party don't qualify. Each person files a separate Claim Form — family members can't combine expenses. There is no right to appeal a denied claim.

• Full out-of-pocket reimbursement

  Reimbursement of what you actually paid for qualifying denied brand-name (single-source) drugs (Jan 1, 2017–May 8, 2026) — no fixed cap. Requires a Claim Form with proof of prescription, proof of payment, and a signed affidavit. You can submit multiple prescriptions on one form.

• $8,850 deductible refund — automatic

  Anyone who paid all or part of the $8,850 brand-name-drug deductible gets it refunded automatically (no claim form) — checks were mailed on/around May 22, 2026.

1. 1Use the Claimant ID & Access Code from page 1 of your mailed Claim Form to file on the official settlement website (or by mail/email).
2. 2Attach proof of prescription, proof of payment (receipt/statement/cancelled check), and the signed affidavit.
3. 3Upload, email, or postmark by November 10, 2026. The $8,850 deductible refund needs no claim form.

1. Order adopting the resolutionMarch 23, 2026
2. Automatic $8,850 deductible refund mailed~May 22, 2026
3. Claim form deadlineNovember 10, 2026

If your claim is approved, reimbursement is mailed within 60 days of receiving your complete claim. Anthem makes an eligibility determination (or sends a denial notice) within 45 days of receiving your Claim Form.

• File using the claim ID from the official notice mailed to class members.
• Administrator: Rust Consulting, Inc.
• Case: In the Matter of Anthem Blue Cross Life and Health Insurance Company · No. File No. PF-2020-02635 · California Department of Insurance (Office of the Insurance Commissioner)