Charter Communications - General Information

Charter Communications, Inc., is an American telecommunications and mass media company with services branded as Spectrum. The company is headquartered in Stamford, Connecticut.

Zendesk Org Tag: Charter Communications

Landing Page: https://www.vida.com/charter

Programs & Devices Offered

• For full details on programs offered, please review this VP card.
• For full details on devices offered, please review Device Eligibility Google Doc.

Critical Update

Effective January 1, 2026  Charter is transitioning its Pharmacy Benefit Manager (PBM) from CVS Caremark to Carelon Integration.This transition will affect how members manage their prescriptions starting 1/1/2026. Carelon will be communicating directly with impacted members starting November 1st, 2025.

On 1/1, VMPs with Charter patients on Mounjaro will receive the following IDO:
Medication Update: Starting 1/1/26 member's insurance plan will no longer cover Mounjaro for weight loss. Please transition to Zepbound.
 

🛑 ALERT: Handling "Plan Exceeding Limits" Rejections (Charter)

The Scenario A Charter member is at the pharmacy trying to pick up a GLP-1 medication (like Zepbound). The pharmacy claims it is rejected due to “Plan exceeding limits.”

Why is this happening? The member likely filled a different GLP-1 medication in the last 90 days. Carelon’s system flags this for safety to prevent doubling up on meds.

✅ Solution 1: Instruct the Member (The Fast Fix) Most of the time, the pharmacist can fix this immediately without making the member wait for us.

Script to Member:

"Please tell the pharmacist that this is a known safety edit. They can override the rejection instantly by entering code SCC 10 or by checking the Prior Authorization (PA) box on their screen."

✅ Solution 2: Escalation (If the Pharmacy Refuses) If the pharmacy doesn't know how to do the override or refuses:

1. Do not tell the member to call the insurance.

2. Escalate to T2 to route the ticket to the CSM/AM team immediately.

3. We will send this to Carelon’s ESR team (copying Charter) to force the override on the back end.

📝 Important Note on Exceptions

• New Rule: We do not need a Prior Authorization (PA) to request an exception for Charter members.

• Action: If an exception is needed, simply request it. Do not wait for PA paperwork.

Member Communications Sent

Charter sent an  email regarding the PBM change and the required provider action has been sent to impacted members.

Key Details of Member Communication:

• Subject: Urgent: Important Changes to Your Medication Coverage (Mounjaro)

• Core Message: Insurance coverage for Mounjaro (for weight loss/OSA) will be discontinued as of January 1, 2026. Zepbound will be covered as the alternative.

• Call to Action: Members are required to schedule and complete an appointment with their Vida provider before the end of January 2026 to discuss the transition plan.

Agents: Please be prepared for increased inquiries regarding the Mounjaro coverage status and scheduling requests. Your primary role is to reinforce the urgency of meeting with the Vida provider.

📢 Charter PBM Transition: Member Update & Formulary 

This information is critical for supporting Charter members regarding the transition to the Carelon Formulary, effective January 1, 2026.

1. Final Medication Formulary Status

The medication list for the Charter Formulary (Carelon) is now complete. The list clearly specifies the Anti-Obesity Medications (AOMs) that are:

• In Scope: Vida providers are able to prescribe.
• Out of Scope: Vida will generally not prescribe (due to being off-formulary or requiring Prior Authorization (PA)).

Agent Action:

• Consult the INTERNAL Carelon-Charter-Vida Process Summary document for detailed guidance on prescribing limitations and procedures.
• The full formulary document (National_Direct_Preferred_4_Tier_ABCBS.pdf) is also available for reference.

2. Corrective Member Messaging Deployed

Charter recently experienced a technical issue that caused some members to receive an incorrect notice stating they could no longer access Vida benefits. This issue has been resolved, and Charter is sending a corrective message to impacted members.

Member Communication Schedule and Details

Agents must be prepared for member inquiries following the distribution of the following materials:

Action Items for Agents

1. Acknowledge the PBM Change: Confirm to members that the PBM is changing from CVS Caremark to Carelon Integration effective 1/1/2026.
2. Anticipate Contrave Calls: Be prepared for calls from the small group of members on Contrave (approx. 16) who received the disruption letter. Confirm the letter was from Carelon and reference the attached document if specific disruption details are needed.
3. Vida Mention: Note that the Contrave disruption letter mentions the Vida program. If asked, remind members this is a resource to support their health and wellness journey.
4. Refer to Carelon: For detailed, personal coverage questions after 1/1/2026, members should be directed to the new contact information provided by Carelon.

AOM Prescribing - Use Case 3

See this VP Card for added prescribing details.

Vida is the only (Anti Obesity Medication) AOM prescriber covered in the plan. 

• Members have access to obesity treatment via Vida's Medical Weight Loss program, which includes an extensive medical intake with labs. They receive MNT and health coaching. They will be evaluated as candidates for AOM at the start of the program and throughout, based on their weight loss progress.
• Vida prescribes AOMs?
  • Yes
• Is this client gold carded?
  • Yes
• Is Contrave covered?
  • Yes 
• Is Zepbound covered?
  • No - starting 7/1/25
• Will members already on GLP-1s who are currently < BMI threshold be grandfathered if they were >threshold at time of initial Rx?
  • Standard goldcarding approach - will request medical records that show the member was w/in target BMI range at time of initial Rx and is currently on the med.
     
  • Update to process for Charter members: 

    • As of January 24, 2025: A doctor’s note about your current medication is no longer required to meet with your Vida medical provider. Instead, Vida will rely on the previous chart notes that your original prescriber submitted to CVS.

      Meeting 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.
      During this visit, you are required to show proof of your most recent weight loss medication 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, the cost of your medication is based on Charter’s Prescription Drug benefit. Weight loss medications are subject to deductible and coinsurance in the Healthy Choice medical option, and copays apply for the Healthy Select and Healthy Advantage medical options.

  • Vida Support for Medication Cost Language:
    • We understand your concern regarding the cost of your medication. While Vida providers can prescribe a weight loss medication, the cost of the medication is based on Charter’s Prescription Drug benefit.
    • If you’re enrolled in Healthy Choice: Beginning January 1, 2025, GLP-1s that are prescribed for weight loss are no longer on the preventive drug list. This means that you will pay 100% of the discounted cost until you meet your annual deductible. This change was communicated during the 2025 Annual Enrollment. As a reminder, deductibles and out-of-pocket maximums reset on January 1, 2025.
    • If you’re enrolled in Healthy Advantage or Healthy Select: Beginning January 1, 2025, the amount you’ll pay for coinsurance and copays will increase for your weight loss medication. This change was communicated during the 2025 Annual Enrollment. See chart below:
    • For details on your specific situation, contact CVS/Caremark at 877-300-6132. Would you like for me to warm transfer you?

Grandfathered Population (on anti-obesity medications prior to 10/1 as known by roster file** and AOM screener question)

• Will be placed in Group MWL
  • Expedite the ability to meet with the NP (take the Condition Control approach)
  • Don't change anchor provider to coach, keep RD
  • Don’t worry about members scheduling their 1 consult with the group provider
    • Members will have labs requested by the Vidabot when Adv. Prescribing team code opens. They will need to send labs before they can schedule with the prescriber.
    • It will take 24 hours from the time they're added to Group MWL program for the Adv. Prescribing team code to be added
    • Members need to meet with prescribers in a video session to get a prescription
• These members will have until 12/31/24 to transition to Vida, or they will receive denial notifications starting 1/1/25
  •  
    • Vida prescribers do not handle refills - these members should work with their outside prescribers for refills until 1/1/25. If they receive PA rejections prior to that date, Support Leads will need to escalate to AM team

**To confirm if the member is part of the grandfathered population, click into their profile in B2B. Under "Eligible User Special Rosters", GLP should be checked.

Scheduling Details for Grandfathered Members

• Note: If members indicate they have AOM in claims OR answer yes to the AOM screener in onboarding, they will still land in Group MWL for which they should get a VMP and AMS without an RD consult. However, their VMP consult would be blocked until Lab/Medical Record/Proof of Prior-AOM prescription, etc are sent and processed.
• Members in group MWL and added to Adv prescribing are blocked from scheduling with VMP, even if all labs and medical records are ingested until they have less than 30 days left on refill (written outside of Vida) - this date is verified when members fill out the AOM screener in the app.
• Members do not need to be a part of the grandfather population (as shown on eligibility file) to join Group MWL, they can also join by indicating they have been prescribed an AOM in the screener.

Grandfathering extension have been offered for Charter Members and they received the email below:

An Update On Vida Health

Last year, we launched Vida Health, a virtual weight management program available to employees and dependents over the age of 18 who are enrolled in an Anthem medical option. As part of this benefit, all weight loss medications must be prescribed by a Vida medical provider to be covered under Charter's prescription drug benefit. Employees and dependents who were prescribed weight loss medication before the launch of Vida were provided instructions on how to transition their existing prescription to a Vida medical provider. Originally, to continue having these medications covered under our prescription plan, the member needed to transition to Vida by December 31, 2024. However, many individuals are still in the middle of the enrollment process. To ensure their treatment is not interrupted, we are offering a one-time extension that will allow these individuals to refill their current prescription through March 31, 2025.

Please note that while Vida providers can prescribe a weight loss medication, the cost of the medication is based on Charter's prescription drug benefit. Weight loss medications are subject to deductible and coinsurance in the Healthy Choice medical option, and copays apply for the Healthy Select and Healthy Advantage medical options.

Please direct employees with questions to Vida at support@vida.com or 855-442-5885.

• Charter & Hilton members can now switch their Vida Medical Provider (prescriber) directly in the Vida app! This update gives them more control and helps them find a prescriber with earlier availability—without needing manual support. 
•  What you need to know:
•  Who? Only Charter & Hilton members (For other orgs, provider changes still go through the escalation flow to our prescribing team, which can take longer.)
•  How? Members go to Settings > Switch Provider in the app.
•  App Update Required! They must update to the latest version via Apple App Store or Google Play to see this feature.
•  How were they notified? Members who don’t have auto-updates were sent email + in-app messages so they know to update.
•  If members reach out, remind them to update their app and follow the steps above. Thanks, everyone! 

Members With Diabetes Requesting Weight Loss GLP-1s

• Who: Charter member self-identifies with diabetes or mentions has been prescribed medicine
  for high "sugars." Has been prescribed weight loss GLP-1 Wegovy/Zepbound by external provider. Finds out "not covered" at the pharmacy.
• When: First refill attempt at pharmacy as of 1/1/2025.
• What: Member calls Vida Support.
• Desired outcome: Prescribing doctor should update patient's medication plan to align with the primary diagnosis of diabetes.
• Next steps:
  • Member contacts the originating prescriber to discuss changing the prescription to alternative formulary-aligned medication.
  • Immediately after enrollment in the Whole Health pathway, the member receives push notification, in-app welcome from the dietitian, and an intro lesson about the program.

Vida Support talking points:

•" I understand you've not been able to fill a prescription for Wegovy/Zepbound from a
doctor outside of Vida and are concerned about getting medication. Thanks so much for
reaching out so I can help you."
• "Please call your doctor to review your insurance plan coverage for your primary
diagnosis."
• "Wegovy/Zepbound are FDA approved for obesity while Ozempic/Mounjaro are FDA approved for diabetes. The active ingredients are the same, but the FDA has approved them for different conditions."
• "Your current doctor is able to prescribe diabetes medications, when appropriate."
• "You may want to ask them whether Ozempic/Mounjaro is appropriate for your treatment. They'll let you know if they need to see you in person or can simply send another prescription to your pharmacy."
• "The Vida Whole Health program is designed to help with diet, exercise, and diabetes management. Your primary care doctor will help you with any medication treatment. And Vida is here to keep helping you with the eating and exercise actions you're taking to manage weight and health conditions such as diabetes."

3/31/2025 Full Transition to Vida

Starting 4/1/2025, Charter members are REQUIRED to enroll in Vida to continue coverage of these medications by CVS/Caremark.

See Talking Points PDF here as your guide to answering FAQs from Charter members.

Population Details

• 114K Total eligibles (84K EE + 30K sp/dep)
• Located throughout US
  Top States: 16% TX, 12% NC, 11% FL

Additional Info

• What segment is this org in?
  • Employer
• Are there any Fees at risk (FAR) org?
  • No
• When did we launch with this org?
  • 10/1/2024
• How is the service being paid for?
  • Vida is available at no cost to US employees, spouses and dependents 18+
• How do members enroll?
  • VSC and self-enroll
• Where should non-eligible members be directed?
  • Charter Benefits Center 844-214-4041 (M-F 8am-8pm ET)
  • CVS customer care 877-300-6132
    • CVS is sending the eligibility file
• Who is eligible?

IMPORTANT: Charter is transition the CVS as their PSM on 3/1/2025, so they'll go through a specific eligibility check that checks against an external file in real time during enrollment. The eligibility file in b2b should be accurate to this external file, but this might not always be the case for some. So while a member may be showing as "terminated" in b2b, they may actually be eligible in the external file.
If you're in this scenario with a member from one of these orgs, it's best that you take them through enrollment (either from the HG platform or walking them through via the mobile app) and perform the real-time check when entering their org. Advise that they have their CVS Caremark ID number ready in the event that they need to put it in for additional verification.

• If members don't qualify for any programs
  • Thank you for calling Vida. I understand you didn’t qualify for the Vida weight loss programs.
    
    Vida weight loss programs are available to eligible members who meet the Body Mass Index (BMI) requirements and are at higher risk of chronic conditions such as high blood pressure, high cholesterol, and prediabetes. Based on the information you provided, your current BMI does not meet the requirements. An intensive telehealth weight loss program may not be safe or recommended for you at this time.
    
    Additional health resources are available through Anthem’s SydneySM Health mobile app or on the website anthem.com.  
    
    Would you like me to transfer you to an Anthem Health Guide [transfer to 866-645-3269] to talk about other options that may be helpful with achieving your goals?
  • For email use macro "Charter - Not Eligible for Any Programs"

• Is the org on the eligibility file?
  • YES
    • IMPORTANT:Pay orgs under our CVS partnership - Lincoln Financial, Schnuck’s Markets, RYAM, Morton Salt, OnVida Health, Charter Communications, Ecolab, Mondelez, KeHE Distributors, Blue Compass RV, Henkel - go through a specific eligibility check that verifies against an external file in real time during enrollment. Right now, the “Eligible users” for these orgs in our B2B system reflect only marketing details and cannot be assumed to be accurate for eligibility checks.
      In order to check members eligibility through these orgs,
      
      • click the “CVS MEMBER LOOKUP” icon on the top right corner of the B2B system. 
      • Select the specific org from the drop-down and fill details (best case is to try their Caremark ID - most members should have their Caremark ID available). If using Caremark ID, no other details are needed. If using Name, make sure to include first and last name with proper spelling, birthday, and Zip Code.
• How often will terminations take place?
  • Monthly
• Why is my Co-Pay suddenly so high?
  • Vida support shouldn’t be discussing benefit plan design or cost share with members. You should direct members to Anthem with these questions.
  • Macro: Charter co-pay/deductible questions: 
    • Please contact Anthem at the number on the back of your insurance card to address questions related to benefit plans, including co-pays or deductibles, with them directly.
• Do we offer Phone and/or Email support?
  • Email + phone
• Is VSC outreach involved?
  • Yes
• CVS Benefits Change FAQs