Jan 18, 2024
Anthem would like to make you aware of regulations that impact pharmacy coverage for your groups with employees in Florida, Arkansas, Oklahoma, Tennessee and West Virginia.
Client impact
The new regulations went into effect on January 1, 2024 and mandate changes to claims processed for members residing in Florida, Arkansas, Oklahoma, Tennessee, and West Virginia, regardless of where the plan is located. As a result, it may be necessary for Anthem to modify certain programs and pricing arrangements with clients and any future contract amendments or renewals. Additional information will be provided soon on what those program and pricing arrangement modifications may be.
Member impact
Impacts to members residing in these states include:
- Removal of mandatory mail pharmacy and exclusive specialty pharmacy arrangements, as these arrangements are no longer permitted. Members will have a 90-day retail pharmacy option. This does not apply to Arkansas residents.
- Possible cost share changes at retail pharmacies as members are not allowed to have higher retail cost shares as compared to prescriptions filled through home delivery.
- Ensuring an alternative specialty pharmacy will be available to dispense members’ specialty drugs if they choose.
Anthem continues to assess solutions to address the regulations while preserving value to your clients’ plans. We will keep you up to date on any additional changes and impacts to your groups’ plan designs for members in impacted states.
