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Anthem Rx Updates Effective October 2019

Recent regulatory changes will impact Anthem Blue Cross pharmacy copays for some of Anthem's 2019 small group plans. The affected copays were different at the time some groups purchased or renewed for 2019 and as a result of these changes, affected plans will be amended effective October 1, 2019.


What is changing?

Tier 1 copays are changing effective October 1, 2019. Specifically, the Tier 1a and Tier 1b split copays will now have a single copay. The new single Tier 1 copay will be the same as the prior Tier 1b copay for most plans, while a few plans will have a completely new Tier 1 copay, please check the Anthem Blue Cross document for more information.


When will groups see this change?

Renewing groups effective October 1, 2019, will see this change at renewal. For all other scenarios, please see below.


January 2019 to September 2019 groups:

  • Any new group or renewing groups on a January 2019 through September 2019 plan will get this benefit change on October 1, 2019.
  • For example, a group that signed up or renewed with Anthem Blue Cross on January 1, 2019 would see their Rx benefits change on October 1, 2019.


November to December 2018 groups:

  • Any current groups with November 2018 or December 2018 effective dates will not see this change until renewal.
  • The Tier 1 changes only apply to 2019, so these groups will not be on 2019 plans until their renewal.


Why is the change happening?

These changes are being made to address regulatory requirements. Affected group administrators and members will receive a letter outlining the changes. Included in that letter will be a table that will provide the copayments prior to October 1, 2019 and the copayment October 1, 2019 and after. Also, the Evidence of Coverage (EOC) will be amended for each affected plan.




For questions, please contact a member of your B&P Sales Team - 888.722.3373