I heard my pharmacy benefits are changing from CVS to Anthem Pharmacy beginning January 1, 2026. What does that mean for me?
Anthem Pharmacy, powered by CarelonRx, will manage your prescriptions beginning January 1, 2026. Anthem Pharmacy uses its own covered drug list. If any of your current medications are not on its drug list, there are other high-quality, cost-effective choices that are available. Additional information can be found on Charter Benefits Central.
Prescriptions for weight loss medications will continue to be covered based on Anthem’s drug list if prescribed by a Vida medical provider. Members should be sure to share their Anthem ID card for pharmacy benefits when checking out at the pharmacy.
What is required to meet with a Vida medical provider in the Medical Weight Loss Program?
These steps must be completed before meeting with a Vida medical provider:
- 1. Initial Enrollment
- Enroll in Vida Health through vida.com/charter or the Vida mobile app.
- In the app, fill out the onboarding questionnaire and select your main health goal.
- Choose your Registered Dietitian and schedule your first consult.
- Members who are on weight loss medications before joining Vida will be able to meet with a Vida medical provider to be assessed to have their prescription continued. Medical records and/or labs may be requested.
- Members who are not on weight loss medications before enrolling in Vida will be initially required to work on Medical Nutrition Therapy with a Vida Dietitian.
- 2. Submit Lab Work
- Submit lab work results* that were completed in the last twelve months that include TSH, CMP, A1c, and Lipid Panel. Let your Vida medical provider know by sending a private “My Care Teams” chat if your most recent lab work was completed more than twelve months ago or if you are missing some of the required results. The provider will send you a lab work order that you can print and take with you to a network lab** of your choice.
- 3. Meet with Your Vida Medical Provider
- Once your lab work results have been reviewed, you will be prompted to set up a visit with your Vida medical provider by clicking the scheduling link in your provider chat.
- If appropriate, based on each individual’s health status and risk factors, members may be assessed and prescribed weight loss medications in accordance with Vida protocols.
- During this visit, if you are currently on a weight loss medication, you are required to show proof of your most recent prescription. Acceptable methods include a pharmacy app with your latest refill or a photo or the physical bottle/box with the prescription label, including your name.
Ongoing participation in Vida is required to continue weight loss medication coverage, and all weight loss medications must be prescribed by a Vida medical provider. While Vida providers can prescribe a weight loss medication, you are responsible for the cost of your medication based on Charter’s prescription drug benefit. Weight loss medications are subject to deductible and coinsurance, and copays may apply.
*Lab results and provider notes can be securely submitted to your Vida medical provider via the Vida app. Within the Vida app go to Settings > My Documents > “Add Documents.” Follow the app instructions to upload a PDF or screenshots.
**For assistance locating a network lab near you, use the “Find Care” tool within the Anthem Sydney app or call Family Advocate at 1-866-645-3269.
What happens if a member is taking weight loss medication that is considered a controlled substance (i.e, Qsymia and phentermine)?
These members can still enroll in Vida Health. Although Vida Health cannot prescribe weight loss medication considered a controlled substance (i.e., Qsymia and Phentermine), alternative medications will be offered if clinically appropriate.
What happens if a member is under age 18 and prescribed a weight loss medication by their provider?
The Vida Health program is not available to enrolled members under the age of 18. These members will continue with the treatment plan prescribed by their non-Vida Health provider, and any weight loss medications will continue to be subject to the prior authorization process through the Anthem Pharmacy plan. These members will become eligible to participate in the Vida Health program when they turn 18 and will then be required to work with a Vida medical provider for their obesity medications to be covered by Charter’s prescription drug benefit.
What happens if I do not work with a Vida Health provider to prescribe my weight loss medications?
Prescriptions for weight loss medications will only be covered by the Anthem Pharmacy if prescribed by a Vida Health medical provider. Individuals who fill a weight loss medication prescribed by a provider outside of Vida Health will be denied coverage at the pharmacy.
Will I have to pay for my weight loss medications if prescribed by a non-Vida Health provider?
For members over 18 years old, if a weight loss medication is prescribed by a provider outside of Vida Health, the medication will not be covered by the member’s Anthem prescription drug coverage benefit. Members will be denied coverage at the pharmacy and will be required to pay for their medication in full to purchase it. Weight loss medications must be prescribed by a Vida Health medical provider to be covered by their Anthem Pharmacy prescription drug coverage benefit.
If Vida prescribes a member a weight loss medication, how does the pharmacy get the prescription?
If a Vida Health medical provider prescribes weight loss medication, prescriptions will be submitted electronically to the member’s pharmacy of choice. It can be a local pharmacy or a mail-order pharmacy. The Vida Health medical provider will ask the member for their preferred pharmacy.
If a Vida Health provider requests lab work, will it be covered by my insurance?
Lab work requested by Vida Health medical providers is typically not considered preventative; therefore, deductible and coinsurance will apply. For more information, contact Family Advocate by calling 866-645-3269, Monday – Friday, 8 a.m. to 8 p.m. ET.
How often will a member meet with their Vida Health provider?
The member will have an initial consultation with their provider to assess their weight loss goals and a follow-up visit to review progress. Additional visits depend on individual situations and can be scheduled as needed. Members also have the option to message their provider for assistance within the Vida Health app on an unlimited basis.
Will members already working with a Vida Health medical provider be able to continue on their medication with the change to Anthem Pharmacy in 2026?
Yes, Vida Health medical providers will still prescribe medications as appropriate and send the prescription to the pharmacy of choice. Members should be sure to present their Anthem ID card when picking up medication from a network pharmacy.
Will the GLP1 Zepbound be covered under the Anthem Pharmacy benefit option?
Yes, Zepbound is a covered medication on the drug list. Quantity limits may apply.
If a member was previously on Zepbound and was switched to Wegovy due to the July 1, 2025 CVS formulary update, what medication will they be prescribed once covered under the Anthem prescription drug coverage benefit?
Members should meet with their Vida Health medical provider to discuss the best option for them. Through the Anthem Pharmacy benefit option, members can continue on Wegovy if it is the best medication based on medical assessment.
If a member was previously on Zepbound and was switched to Mounjaro due to the July 1, 2025 CVS formulary update, what medication will they be prescribed once covered under the Anthem prescription drug coverage benefit?
Members currently taking Mounjaro for weight loss will be required to switch to Zepbound (both contain the same medication, tirzepitide, but different brands) since Zepbound will be a covered medication on the Anthem Pharmacy benefit plan.
