California members of Anthem Blue Cross’s grandfathered Core 5000, Tonik and RightPlan policies have until Tuesday, November 10, to ask for money back on brand-name prescriptions they paid for after Anthem refused coverage. The claim window covers purchases from January 1, 2017 through May 8, 2026. It grew out of a state insurance regulator’s case against the company, which agreed to pay a $750,000 penalty.
A regulator’s case, not a class action
Open Class Actions, a settlement tracker, lists the matter as In the Matter of the License and Licensing Rights of Anthem Blue Cross Life and Health Insurance Company, File No. PF-2020-02635, before the California Department of Insurance. The department read Insurance Code section 10123.201 to require coverage of medically necessary brand-name drugs under certain grandfathered plans.
The case was resolved through a Special Notice of Defense, adopted by an order effective March 23, 2026, without an evidentiary hearing. Anthem pays the $750,000 penalty to the department, and the tracker says Anthem does not concede that the statute required it to cover these drugs.
The department alleged that Anthem did not cover the drugs and that some members were made to pay an $8,850 deductible for brand-name coverage. That second charge produced a separate refund, described below, that required no claim.
Which plans, which purchases and what has to be shown
Four plan names qualify: Anthem Core 5000, Tonik DN14, Tonik DN15 and RightPlan with generic prescription drug coverage. The purchase must have been a brand-name, single-source drug that the plan would otherwise have covered, denied solely because it was brand-name. No other plan or third party can have reimbursed it.
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Each person files a separate claim form, and family members cannot combine expenses. Several prescriptions can go on one form. The amount paid back is the actual out-of-pocket cost, with no fixed per-person payout and no published cap.
Proof comes in three parts, according to the tracker: a copy of the prescription or written verification from the prescriber or pharmacy, proof of payment such as a pharmacy receipt, card statement or cancelled check, and a signed affidavit under penalty of perjury that the member paid and was not reimbursed.
Online filers need the claimant ID and access code printed in the upper right corner of page 1 of the mailed claim form. Claim Depot lists administrator Rust Consulting’s phone line as 855-720-6806, and lost forms or credentials can be requested through the contact page on the official site.
What happens after a claim is filed
The form can be uploaded, emailed or postmarked by November 10 at the official site, grandfatheredrxsettlement.com. Anthem then has 45 days from receipt to decide eligibility or send a denial notice. If the claim is eligible, a check follows by mail within 60 days of Anthem receiving the complete claim.
An incomplete claim gets one chance to be supplemented. That deadline is November 10 or 30 days after a denial notice, whichever is later. The tracker also states that there is no right to appeal a denial, which makes a complete first filing the better bet.
Notice and claim forms were mailed beginning May 8, 2026. A member who lost the mailed form still has until the same November 10 date, with the replacement requested through the administrator’s contact page.
The order names Anthem Blue Cross Life and Health Insurance Company, and the tracker lists only those four plans, so members of other Anthem policies are outside this claim process. A member unsure which plan paid for a purchase can check the plan name on the insurance card.
The $8,850 deductible refund came without a claim
Members who paid all or part of the $8,850 deductible tied to brand-name drug coverage are refunded automatically, with no claim form needed. The tracker says the checks were mailed to the address on file on or around May 22, 2026. Anyone who did not receive one is told to use the contact page on the official site.
Class Action Champion likewise lists reimbursement of out-of-pocket drug costs and refunds of the $8,850 deductible as the two forms of relief, and gives the same November 10 date. Neither tracker lists a total fund beyond the penalty or a count of affected members, and Class Action Champion notes it is not the official site and tells readers to confirm details on the claim site before filing.
The tracker also carries a warning: Anthem and the administrator will not call, text or email to demand a fee, a full Social Security number or a bank login. Filing and the deductible refund are free, so any contact asking for money first is not part of this process.
The date works against anyone who still needs the paperwork. Drug purchases from as far back as 2017 mean old pharmacy receipts and card statements, and a request to a pharmacy or prescriber for written verification takes time. With the window shutting in 15 days, the first step is finding out which brand-name purchases Anthem actually refused.
Paid cash for a denied brand-name drug?
The Anthem claim asks for a prescription record, proof of payment and a signed affidavit, and a denial of the claim cannot be appealed. A member who cannot lay hands on a 2019 receipt by November 10 gets nothing back for that purchase.
The Medicare Cost & Coverage Protection Kit does a different job: it keeps the record for the next denial. It includes the prior-authorization appeal steps, which apply to a coverage denial that is still open, and a medication and cost tracker that logs each fill, price and denial date. It does not file the Anthem claim.
Log every prescription denial and cost with the Medicare Cost & Coverage Protection Kit tracker →
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This article was produced with AI assistance and edited for accuracy against the sources linked above.
Warren Cohen is a finance writer based in Phoenix, Arizona, covering personal finance topics including credit, banking, and beginner investing. He earned his degree in business administration from Arizona State University and began his career working in consumer finance, where he gained direct experience with lending and credit systems. He now writes for personal finance websites and fintech platforms, focusing on clear, practical content that helps readers make informed financial decisions.
