These benefit changes will reduce member cost share for Mental Health, Behavioral Health and Substance Use Disorder (MH/SUD) and emergency medical transportation benefits. Previously filed claims will be retroactively adjusted back to dates of service on or after January 1, 2016. Members who paid the incorrect cost sharing amount will receive a separate letter and refund, as appropriate.
The letter will explain that Anthem Blue Cross has noticed a potentially risky pattern in the way they’re getting prescriptions filled. They will have 60 days to change this risky behavior. If Anthem Blue Cross doesn’t see a change in their drug claims within 60 days, they’ll follow up with another letter.
Anthem Bronze PPO members with contract codes 1FZ3 and 1FZ4 received Benefit Comparison Charts in their 2016 Open Enrollment Kits that had incorrect coinsurance amounts listed for Tier 4 pharmacy benefits. The 2016 Tier 4 Retail Pharmacy benefits were listed as 0% coinsurance up to $500, and the Tier 4 Mail Order Pharmacy benefits were listed as 0% coinsurance up to $1,500. These amounts are not correct. The correct pharmacy benefits for 2016 are as follows: