Coverage of OTC COVID Test Kits
January 14, 2022
Coverage of OTC COVID Test Kits
Jan 14, 2022, 15:24 PM by Courtney Fitzgerald
UPDATE AS OF FEBRUARY 24, 2022:
CVS Caremark has provided a flyer with the process members need to follow to receive coverage for at-home COVID tests. Click Here for the flyer.
UPDATE AS OF JANUARY 21, 2022:
Federal Regulations were released Monday, January 10 regarding coverage for Over the Counter (OTC) at-home COVID-19 tests. The effective date of coverage began on January 15, 2022. Due to the short timeframe between issuance to implementation, there has been significant confusion about the coverage of at-home COVID-19 tests, how to obtain them, how to get reimbursed for them, and what exactly is covered.
Listed below are some important items and reminders for members wishing to use this benefit:
- Members do NOT need a prescription to purchase and receive benefits for at-home COVID-19 tests through the SEHP prescription plan with CVS Caremark.
- For members of the SEHP, at-home COVID-19 tests are covered only through the CVS Caremark Prescription benefit. They are NOT covered under the medical plan (BCBSKS or Aetna).
- This update applies to all members of the SEHP under the Caremark Prescription benefit.
- These are NOT the same as the 4 free tests per household being offered through the Federal Government.
- A member’s coverage includes up to 8 tests per covered individual per 30-day period.
- If a member purchases a multi-pack of tests, each test in the package counts as a single test.
Direct Network Pharmacy Purchase
- Some pharmacies will be able to file and process claims directly for members. Members will need to inquire at the Pharmacy counter (not the retail counter at the front of the store) to know if their pharmacy is able to file directly with CVS Caremark. If a pharmacy is able to file directly on the member’s behalf, the member cost share will be $0.
- To locate a Network pharmacy, visit the locator tool through the CVS Caremark member portal
- Only select tests are covered through direct pharmacy purchase, including
- ACON FLOWFLEX COVID-19 AG HOME TEST
- ACCESS BIO ON/GO COVID-19 ANTIGEN SELF-TEST
- ABBOTT DIAGNOSTICS SCARBO BINAXNOW COVID-19 AG CARD HOME TEST
- ORASURE TECHNOLOGIES INTELISWAB COVID-19 RAPID TEST
- QUIDEL QUICKVUE AT-HOME COVID-19 TEST (2-pack)
- QUIDEL QUICKVUE AT-HOME COVID-19 TEST (5-pack)
Non Network Pharmacy, Retail Location, or Online Retailer Purchase
- If a member purchases test kits at the “front of the store” (retail counter), through a Non Network pharmacy, or through an online retailer, they will need to pay for the tests out of pocket and file a claim for reimbursement.
- The claim can be filed through the online CVS Caremark member portal or through a paper claim form linked here.
- If filing a claim for reimbursement, the maximum reimbursement amount allowed under the guidelines is $12 per test. A copy of the purchase receipt must be included with the claim submission.
- Typically, a claim form will take 30 days to be processed and reimburse the member by check.
- All manufacturers/brands are eligible for reimbursement under this benefit.
- Home collection PCR tests are not covered at this time.
- CVS Caremark has provided a very helpful FAQ for members regarding at-home COVID-19 tests. You may access that FAQ here.
- Additional information regarding at-home COVID-19 tests is available through the CDC.
- Due to the recent increase in COVID-19 cases, home test kits may be hard to find. To locate a KDHE testing location near you, visit KnowBeforeYouGoKS.com.
- COVID-19 testing is also available free of charge to SEHP members and state employees through the HealthQuest Health Center in Topeka, KS. Appointments may be scheduled by calling 785-783-4080.
JANUARY 14, 2022:
On January 10, 2022, federal agencies announced that health plans must cover over-the-counter (OTC) COVID-19 tests, “without imposing any cost-sharing requirements, prior authorization, or other medical management requirements.” Coverage is effective Saturday, January 15, 2022, for tests purchased on or after that date, during the public health emergency. A doctor’s prescription is not required.
Members may purchase OTC COVID-19 tests from a Network pharmacy by presenting their CVS Caremark card at the point of purchase. To find a list of Network pharmacies near you, log in to your CVS Caremark member portal.
Should members choose to purchase OTC COVID-19 tests from a Non Network pharmacy, they will need to submit a paper claim form and receipt of purchase to CVS Caremark for reimbursement. Reimbursement may limited when purchased from a Non Network pharmacy. The SEHP will continue to cover COVID-19 tests administered by health care providers as a preventive service.
Members are limited to 8 tests per covered member per 30 days. For example, Sally has Member + Children coverage for her and her three children. Sally would be limited to 8 tests per covered member per month for a maximum of 32 tests for her and her three children per month.
We will send an email notification to all members later today regarding the coverage changes.
Additional guidance continues to be issued, and we will update you as needed.
Should members have any questions, they may call CVS Caremark at 800-294-6324 or email the SEHP at SEHPBenefits@ks.gov