Under the new strategy by the Biden-Harris administration, Americans with private insurance can get up to eight at-home rapid test kits a month for free. With a surge of omicron variant cases, at-home rapid testing is crucial to slow the spread of the COVID-19 pandemic. With the new development, many people will likely have to pay out of pocket for the rapid tests and then file for reimbursement with their health insurance and not the federal government. In addition, pharmacy problems and billing come with the new emergency rule, as some pharmacies may not be well prepared and may not have those tests available (Neal, 2022). This report will provide information on how various Alabama insurance companies provide reimbursement for at-home COVID-19 tests.
How Insurers Are Reimbursing Members in Alabama
On January 10, 2022, the federal government announced that self-read, at-home COVID-19 tests purchased on or after January 15, 2022, will be covered by health insurers. In the State of Alabama, the following insurance companies reimburse its members.
Prime Therapeutics
Prime Therapeutics has established arrangements for convenience coverage with no upfront costs when the tests are billed and received to members’ insurance through a pharmacy. The preferred pharmacy lists are accessible at the members’ health plan website. Amazon pharmacy online requires a prescription to submit a claim under these plans (Prime Therapeutics, 2022).
To obtain free at-home COVID-19 tests, no prescription is needed. And the tests covered under Prime Therapeutics are Ellume COVID-19 Home Test, InteliSwab COVID-19 Rapid Test, QuickVue At-Home OTC COVID-19 Test, BinaxNOW COVID-19 Ag Card Home Test, among others. Tests that a lab or prescribed tests must read are not processed through a member’s pharmacy benefit, and members are encouraged to contact their health plans for more information regarding such tests (Prime Therapeutics, 2022).
Only at-home tests on the coverage list are eligible for reimbursement through the members’ pharmacy coverage, and other at-home tests are not covered. For non-preferred pharmacies online and local retailers, the plan will reimburse members at 100% of the cost up to a maximum of $12 per individual test and only eight over-the-counter (OTC) at-home tests per month per member can be reimbursed. When using preferred pharmacies, members can go to the pharmacy counter and have a claim submitted for them at no cost, and members will be reimbursed a maximum of $12 per individual test. Rapid tests required for employment or resale at home are not eligible for reimbursement (Prime Therapeutics, 2022).
How to submit for reimbursement
You have to fill out a drug claim form and the receipt from the retailer where the OTC rapid test kit was purchased and send it to the address on the form. The standard turnaround time for reimbursement is 21 days under the plan. However, additional time may be required to process reimbursement requests depending on volume. But purchasing these tests through preferred pharmacies will eliminate the need for reimbursement. In addition, rapid OTC tests purchased before January 15 will not be covered (Prime Therapeutics, 2022).
Viva Health
To receive at-home OTC rapid tests covered at 100% with no out-of-pocket cost, Viva Health members are encouraged to purchase those kits at a participating pharmacy at the pharmacy counter. Viva Health members who have insurance plans through their employer have OTC at home COVID-19 diagnostic tests coverage. This benefit does not apply to Medicare members. For members to be eligible for coverage, at-home tests must be purchased on behalf of or by members for personal use and not for employment or resale purposes. Qualified tests are purchased from January 15, 2022, through the end of the public health emergency. Members can ask for reimbursement up to 180 days from the purchase date (Viva Health, 2022).
How the tests will be covered
Individuals with prescription drug coverage under Viva Health can now purchase at-home diagnostic tests from the participating pharmacy and receive the tests at no cost. Members should present their Viva Health member ID at the pharmacy counter to obtain the tests. However, members who purchase these tests outside participating pharmacies’ networks will have to pay out of pocket, and reimbursement will be limited to $12 per individual test (Viva Health, 2022).
Members with prescription drug coverage can file for reimbursement for tests bought out of pocket through the plan’s pharmacy benefit manager, Express Script. At home COVID-19 tests purchased before February 1, individuals should submit a request for reimbursement to Viva Health’s commercial claim department. They should complete the form and include the original receipt and UPC barcode from the test box. The at-home tests are generally available at retail and online stores and pharmacies, but availability depends on national supply. Also, all Americans are eligible to order four free tests at the COVIDtests.gov site. Only tests with emergency use authorization or Food and Drug Administration approval are eligible for reimbursement. In addition, the Viva Health plan only covers eight tests per member per 30 days (Viva Health, 2022).
Bright HealthCare
Starting January 15, Bright HealthCare covers at-home rapid COVID-19 tests for family and individual plans and small group members. Therefore, members can purchase the OTC at-home tests online or at a store or pharmacy, but the diagnostic tests must be FDA authorized (Bright HealthCare, 2022).
Members will be required to pay upfront and the plan will reimburse you. After a member has purchased a test, they must submit a reimbursement claim form along with the proof of purchase to the Bright HealthCare mailing address listed on the form. The plan will then reimburse members for the actual cost of the test when they submit the claim form and provide proof of purchase. Only tests bought on or after January 15, 2022 are eligible for reimbursement. Bright HealthCare pledges to reimburse its members promptly. However, the health plan is not required to cover work mandated tests (Bright HealthCare, 2022).
Blue Cross and Blue Shield (BCBS) of Alabama
BCBS of Alabama has a network of pharmacies that will bill the at-home rapid tests and process them at no cost for their members. However, the eligible tests must be FDA authorized, and the plan only covers eight tests per member per month. To fill in for reimbursement for tests purchased out of network, members should find a claim form and fill them, submit the paper claim request form along with the receipt and UPC barcode and send through the email details provided in the form. Members will be reimbursed up to $12 per test kit (The University of Alabama in Huntsville, 2022).
Summary
Adopting the Biden emergency rule has not been easy for insurance companies. However, companies like Prime Therapeutic, VIVA health, BCBS of Alabama, and Bright HealthCare of Alabama provide at-home OTC rapid tests that are FDA authorized. VIVA Health and Prime Therapeutic will reimburse their members up to $12 per individual test. However, Alabama Medicaid and Bright HealthCare have not stated the actual amount but will reimburse the cost used by members. The number of tests covered is eight per 30 days per member, and members can obtain these tests online or at preferred pharmacies. Uninsured individuals in the State of Alabama are encouraged to obtain free tests through the government website.
References
Bright HealthCare. (2022). Coronavirus and Coverage – Bright HealthCare. Brighthealthcare.com. Retrieved February 7, 2022, from
Neal, M. (2022). Taking advantage of getting free at-home COVID-19 tests. whnt.com. Retrieved February 7, 2022, from https://whnt.com/news/coronavirus/taking-advantage-of-getting-free-at-home-COVID-19-tests/.
Prime Therapeutics. (2022). COVID 19 At Home Test Kits. Uah.edu. Retrieved February 7, 2022, from
The University of Alabama in Huntsville. (2022). How to use your health plan benefit to access COVID-19 tests. The University of Alabama in Huntsville. Retrieved February 7, 2022, from
Viva Health. (2022). COVID-19 | Viva Health. Vivahealth.com. Retrieved February 7, 2022, from https://www.vivahealth.com/coronavirus/.
