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1+: Anthem Tightens Rx Refill Process

Sep 08, 2016

To reduce medication waste and encourage dosage compliance, Anthem has tightened their prescription refill process for California members. As always, prescription refills are allowed after a certain percentage of the previous fill has been used.

What's changed? 

As of July 20, 2016, this percentage has changed from 68% to 75% for Home Delivery (mail-order) prescriptions and 75% to 85% for prescriptions filled at a retail drugstore. This change does not apply to members in Affordable Care Act (ACA) group plans, as 75% for mail-order and 85% for retail were already in place. 

For Anthem members, this change means:

*These exceptions are subject to specific guidelines and limitations. 

Some prescription claims filled from July 20, 2016 through August 25, 2016 for California members in Anthem group plans may have been rejected based on the refill being too soon. This resulted from an update for retail and mail-order claims that included a 180-day look-back for fills of the same medication. 

Likewise, some prescription claims filled during the same time period for California members in ACA plans (individual or small group) may have been rejected as refilled too soon. This, too, was the result of a similar update for retail claims that included a 180-day look-back for fills of the same medication.

Due to member feedback, the additional look-back step has been removed from the refill process as of August 26, 2016.

For questions, please contact a member of your b&p Sales Team - 888.722.3373.

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