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Consumers covered under an Anthem Blue Cross Life and Health Insurance Co. health plan who paid out of pocket for a brand name (single-source) prescription drug between Jan. 1, 2017, and May 8, 2026, may be eligible to claim expense reimbursement from a class action settlement.
Anthem Blue Cross Life and Health Insurance Co. agreed to settle a class action lawsuit claiming it failed to cover medically necessary brand name prescription drugs for certain “grandfathered” health insurance policies as required by California law. The settlement also resolves claims that Anthem charged some members an $8,850 deductible for brand-name prescription drugs.
Who can file a claim?
Class members must meet all of the following criteria:
- One of these Anthem health plans covered them at any time between Jan. 1, 2017, and May 8, 2026:
- Core 5000
- Tonik DN14
- Tonik DN15
- RightPlan (with generic prescription drug coverage)
- They personally paid out of pocket for a brand name (single-source) prescription drug during this period.
- Their health plan would have otherwise covered the prescription, but Anthem denied it solely because it was a brand name (single-source) product.
- Any other health plan or third party did not reimburse them for their out-of-pocket costs for the drug.
Each individual seeking reimbursement must submit a separate claim form. Family members cannot combine their claims on a single form. Those who need additional space to list their expenses can download extra claim forms from the official settlement website or request them by emailing info@GrandfatheredRXSettlement.com.
How much can class members get?
Eligible class members can receive reimbursement for the full amount of what they paid for out-of-pocket expenses for brand name (single-source) prescription drugs that Anthem denied solely because they were brand name products.
Out-of-pocket expenses do not include any costs covered or reimbursed by another insurance plan, health care service plan or from the proceeds of any other judgment or settlement specifically designated for medical expenses.
For those who paid all or part of the $8,850 deductible for brand name prescription drugs, Anthem will automatically mail a refund for the amount they paid. Class members do not need to submit a claim form to receive this refund.
How to claim a settlement payment
Eligible class members can file a claim online or download and print a PDF claim form, complete it and mail or email it to the settlement administrator:
- Settlement administrator's mailing address: Special Notice of Defense, c/o Rust Consulting Inc. - 9167, PO Box 2599, Faribault, MN 55021-9599
- Settlement administrator's email address: info@GrandfatheredRXSettlement.com
What proof or documentation is necessary to submit a claim?
All class members must submit the following documentation with their claim form:
- A copy of the prescription or written verification from the prescribing provider or dispensing pharmacy for each drug listed
- Proof of payment showing the class member personally paid out of pocket for the drug (such as a pharmacy receipt, credit card statement or cancelled check)
To file an online claim, class members must provide the unique claimant ID and access code from the settlement notice they received.
The settlement administrator will not process claims that do not contain all required documentation. If a class member's claim is incomplete, the administrator will contact them with one opportunity to submit supplemental information. If they do not provide adequate proof, the administrator will deny the claim.
Payout options
The settlement administrator will automatically mail deductible refunds to the policyholder's address on file with Anthem. It will mail out-of-pocket cost reimbursement for approved claims to the address the class member provides on the claim form.
Important dates
- Deadline to file a claim: Nov. 10, 2026
When is the Anthem brand name drug payout date?
- For all insureds whom Anthem required to pay all or a portion of the $8,850 deductible for coverage of brand name prescription drugs, the settlement administrator mailed refunds on May 22, 2026.
- For those who file a claim, Anthem will make a determination of eligibility within 45 days of receipt of the class member's claim form. If the class member is eligible for reimbursement, Anthem will issue a check within 60 days of the date it receives the class member's claim form and supporting documentation.
Why did this class action settlement happen?
The California Department of Insurance alleged Anthem Blue Cross Life and Health Insurance Co. failed to cover medically necessary brand name prescription drugs for certain “grandfathered” health insurance policies as required by California law.
Rather than proceed to an evidentiary hearing, Anthem agreed to resolve the charges by reimbursing eligible policyholders for their out-of-pocket expenses and refunding all or a portion of the $8,850 deductible it charged to some members.
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