Pharmacy Benefits

Pharmacy Benefits for Anthem members with CarelonRx pharmacy

 

Effective Jan. 1, 2026, Anthem medical plan participants will have an integrated medical and prescription drug benefit experience. The Anthem Blue Cross Blue Shield (BCBS) pharmacy benefit manager, CarelonRx, will replace CVS Caremark as the prescription drug vendor.

 

This change will reduce overall cost increases which helps avoid otherwise larger needed premium and out-of-pocket cost increases. You and your family will also get enhanced service from Anthem.

 

If you are only using pharmacy benefits through RTX, you can review those retiree plans here.

What you need to know:

 

Your prescription drug plan design is not changing and there will be minimal disruption to prescriptions during the transition. The CarelonRx pharmacy network is very similar to the CVS Caremark network (CVS retail pharmacies participate in the CarelonRx pharmacy network).

  • Your current prescriptions will automatically transfer from CVS Caremark to Anthem’s pharmacy benefit manager, CarelonRx, managing both home deliver and specialty medications by Jan. 6, 2026. Exceptions include:
    • Any controlled substance or compound medication prescriptions. Per federal law, controlled substance prescriptions cannot be transferred.
    • Any open prescription (meaning it hasn’t been filled yet) for a non-controlled substance.
  • If you take a specialty medication (such as for the treatment of cancer) that is currently filled by the CVS Specialty Pharmacy, that prescription will transfer to Anthem’s BioPlus Specialty Pharmacy, if there are remaining refills. Anthem will mail you a letter and BioPlus will call you with information about how to fill your specialty medication in 2026 and to help get you set up with BioPlus.

What you need to do:

 

You must take the following actions by Dec. 31, 2025:

  • Continue to fill any prescriptions with CVS Caremark through Dec. 31, 2025.
  • Download the free Sydney Health app from Anthem. Beginning in 2026, you can use the Sydney Health app and view your personalized pharmacy experience including a profile of medications, compare medication prices and one-click prescription requests. What's more, you can chat with a pharmacist 24/7. It’s available for both Apple and Android phones.
  • If you are due for a prescription refill in December, you may fill it with CVS Caremark. Generally, prescriptions can be refilled when 75% of the medication has been used based on the previous fill date.
  • If you have a controlled substance or compound medication prescription, request a new prescription from your doctor for refills starting in 2026.
  • For your own safety and security, you will need to enter any payment information that you might have entered with your previous pharmacy benefit manager.
  • To get the most from your benefits, confirm that the retail pharmacy you use today is in the Anthem Base pharmacy network. Call an Anthem Family Advocate at 866-251-1803 to check.

Pharmacy Benefit Plan Details

body

RTX retiree plans for Anthem medical members

 

If you are only using pharmacy benefits through RTX, you can review those retiree plans here.