January 25, 2022
At-home COVID-19 testing updates
On Jan. 10, the federal government announced that they had directed health insurance plans to cover the cost of certain at-home and over-the-counter COVID-19 test kits. Accordingly, the State Employee Health Plan, or SEHP, began to cover certain OTC tests purchased Jan. 15 through the duration of the public health emergency.
The SEHP and CVS Caremark, the pharmacy benefits manager, have provided the information below to help clear any confusion or concerns caused by the limited timeframe between the directive and implementation.
• OTC COVID-19 tests are covered only through CVS Caremark and not through medical insurance carriers such as Aetna and Blue Cross Blue Shield of Kansas.
• Members do not need a prescription to purchase and receive benefits for these COVID-19 kits. Some pharmacies will be able to file and process claims directly. Please work with the pharmacy instead of the retail counter, where applicable, to have CVS Caremark billed directly. The member cost will be $0 when the pharmacy can bill directly on the member's behalf. Tests purchased at the retail counter may require members to submit a reimbursement request even if the pharmacy is considered in-network.
• Only select tests are covered through a 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-10 RAPID TEST
- QUIDEL QUICKVUE AT-HOME COVID-19 TEST (2-pack)
- QUIDEL QUICKVUE AT-HOME COVID-19 TEST (5-pack)
• Coverage is limited to eight tests per 30 days for each covered member. Packs with multiple tests will apply to this limit.
• Kits purchased at the retail counter, through a non-network pharmacy, or online retailer will require members to file a claim for reimbursement. The maximum reimbursement provided will be $12/test and a receipt must be included with claim submission. Reimbursement requests can be filed online in the member portal or via paper form and typically take 30 days prior to payment via check issued to the member.
The federal government is also providing up to four free tests per household via Covidtests.gov. Order updates will be available by email if provided at the time of request. Those without computer access or who need additional assistance may request these no-cost kits at 800-232-0233. These kits are offered independently of SEHP and do not impact availability under members' pharmacy benefits. Additional details regarding the federal distribution and availability of free N95 masks are forthcoming.
HCS will provide additional updates as they become available. Please contact your HCS benefits team at email@example.com if we may be of service or support.