CarelonRx, our pharmacy benefit manger, is enhancing the specialty pharmacy home delivery experience for ASO groups, including JAA. Starting January 1, 2026, the standard set up will move from a 30-day to a 90-day supply limit. For those with 4-tier benefit designs, the member cost share will adjust to up to three times the 30-day copay or coinsurance limit, based on the drug's cost and allowed amount. Tier 2 and Tier 3 design costs remain unchanged.
This benefit change will only impact ASO clients. The following are out of scope:
- Individual and Small Group plans
- ASO clients using Fully Insured plans
- Small Group MEWA benefit plans
- Small and Large Group ABF benefit plans
Clients renewing between January and March 2026 should receive notification letters starting September 30, 2025. These changes will be discussed during renewal or implementation for new clients. This update aims to improve member experience, medication adherence, and outcomes.
If you have any questions, please reach out to your Anthem representative.