CarelonRx, our Pharmacy Benefit Manager, announced a pharmacy network update to the RxChoice network beginning January 1, 2026.
Less than 5% of current retail pharmacies are changing from Tier 1 to Tier 2. Tier 1 pharmacies offer a lower share of the costs to members. Tier 2 pharmacies are in network, but the medication costs are higher. No pharmacies will be removed from the network. Members can remain at their current pharmacy, but some may pay a higher cost for continuing to fill at a Tier 2 pharmacy.
The impacted clients include Individual, Small Group, Large Group, and National Accounts. The network will continue to maintain its national presence, encompassing 62,000 pharmacies across the U.S.
To help ease this transition, affected members will receive a letter if their pharmacy is changing tiers. We'll also provide them with the three nearest in-network pharmacy locations based on their zip code.
Members have the option to use the Find a Pharmacy feature on the SydneySM Health app or anthem.com (upstate / downstate) after January 1, 2026. Or they can reach out to Pharmacy Member Services number on the back of their ID card to locate a fresh in-network pharmacy.
If you have questions about this change, please reach out to your Account Manager.
Sydney Health is offered through an arrangement with Carelon Digital Platforms, a separate company offering mobile application services on behalf of your health plan.