On January 10, the Biden Administration issued guidance requiring all group health plans and health insurers to cover OTC COVID-19 tests without member cost share effective January 15, 2022. This new requirement:
Allows consumers with commercial health coverage to seek reimbursement from their health plan for OTC tests they purchase online or in-person without the direct involvement of a health care provider.
Requires health plans to cover, without cost sharing, up to 8 OTC tests per member per 30 days (if kits contain 2 tests, then no more than 4 kits per 30 days).
Maintains the policy that plans are only required to cover tests intended for diagnosis or treatment (versus routine screenings for employment, school or recreational purposes).
Note: This mandate is in effect until the end of the federal public health emergency. Any tests purchased pursuant to a physician’s order will not be subject to the quantity limit.
Insurers are incentivized to work with preferred pharmacies to remove upfront costs for members. If insurers do not set up a preferred pharmacy network will have to cover more of the costs.