Kentucky, Alabama, Montana, Colorado, Idaho, Iowa, Indiana, Louisiana, and Oklahoma, and several other states have introduced regulations that may impact members with pharmacy coverage and pricing arrangements with Anthem or CarelonRx.
The mandated changes generally apply to claims processed by pharmacies in these states and members residing in these states regardless of where the plan and, in some instances, the pharmacy, is located.
Client impact:
- The following states have enacted legislative changes affecting pharmacy claims: Kentucky, Alabama, Montana, Colorado, Idaho, Iowa, Indiana, Louisiana, and Oklahoma.
- Impacted claims will now move from spread pricing to pass-through pricing with a $1.50 admin fee and will be excluded from discount and dispensing fee guarantees for clients with spread pricing.
- Claims in these states will be excluded from any pricing guarantees.
- Exclusive specialty arrangements and mandatory mail requirements will not apply to impacted members. Members will have a 90-day retail pharmacy option.
We will mail or email affected clients about these changes in the next three weeks. We continue to look for solutions to address the regulations while preserving value in your clients’ plans. We will keep you updated on any additional changes and impacts to your groups’ plan designs for members in impacted states.