As you may have heard, on January 10, 2022, The Departments of Labor, Treasury, and Health and Human Services released guidance to support the Administration's directive that health insurers and group health plans cover, subject to certain criteria, the cost of FDA-authorized and approved over-the-counter (OTC) at-home COVID-19 tests beginning on January 15, 2022.
On January 15, 2022, group health plans have to cover FDA-authorized and approved OTC at-home COVID-19 diagnostic tests without a doctor's prescription or clinical assessment. This at-home COVID-19 test benefit includes up to 8 tests per member per 30 days.
There are two ways under our pharmacy benefit to receive the tests:
Direct Coverage: Plan will cover the cost of OTC COVID-19 tests with direct reimbursement to the pharmacy and no upfront out-of-pocket cost for members without a prescription. Member simply presents the prescription benefit ID card to any participating pharmacy that elects to offer COVID-19 tests through the program
Direct Member Reimbursement: Plan will reimburse the cost of OTC COVID-19 tests without a prescription after purchase if you do not utilize a participating pharmacy or you do not present your prescription benefit ID card, starting January 15, 2022 until the end of the Public Health Emergency. Members can upload a copy of their receipt of the OTC COVID-19 tests purchased via caremark.com to submit for reimbursement or submit a paper claim. The member will be reimbursed, and the plan will pay the lesser of the full retail price paid by the member or the $12 per test reimbursement limit established by the Administration.
Please visit https://www.caremark.com/covid19-otc.html with questions.
In addition, to make getting test kits easier, the Biden administration is making free OTC COVID-19 tests available through the federal government. Please refer to the following link: https://special.usps.com/testkits