Anthem Grandfathered Plan Brand-Name Prescription Drug Settlement

Under a settlement with the California Department of Insurance, Anthem Blue Cross is reimbursing members of certain grandfathered individual health plans who were denied coverage for medically necessary brand-name drugs or hit with an $8,850 brand-name deductible. Members who paid out of pocket for single-source brand drugs between 2017 and May 2026 can file for their expenses, with supporting documentation, using the notice package mailed May 8, 2026. Deductible refunds are being issued automatically without any filing. Claim forms must be postmarked by November 10, 2026, and Rust Consulting administers the program.

People covered under Anthem Blue Cross Core 5000, Tonik DN14, Tonik DN15, or RightPlan (with generic-only drug coverage) policies who paid out of pocket for a brand-name, single-source prescription drug between January 1, 2017 and May 8, 2026 after Anthem declined to cover it solely because it was a brand-name product.

Reimbursement of eligible out-of-pocket brand-name prescription costs; members charged the $8,850 brand-name deductible receive automatic refunds with no claim form needed.

No payment amount is ever guaranteed. Pro rata payouts shrink as more valid claims come in, and every payment waits on final court approval and any appeals.

This settlement requires documentation. Check the official claim form for exactly what is accepted before you start; receipts, account statements, repair invoices, or records from the defendant are typical.