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Biden issues guidance for health plans to cover COVID-19 tests

Insurers encouraged to cover costs up front through pharmacies and retailers

Grubb's Pharmacy on Capitol Hill in Washington is pictured on April 12, 2021.
Grubb's Pharmacy on Capitol Hill in Washington is pictured on April 12, 2021. (Tom Williams/CQ Roll Call)

Private health insurance plans will cover up to eight over-the-counter COVID-19 tests per consumer each month under a new Biden administration directive meant to make tests more affordable.

Tests purchased beginning on Jan. 15 will be covered. The departments of Labor, Health and Human Services, and Treasury released guidance outlining the policy Monday, which urges insurance plans to cover the cost of tests up front, but also provides the option to reimburse enrollees for the purchase.

“This is all part of our overall strategy to ramp-up access to easy-to-use, at-home tests at no cost,” HHS Secretary Xavier Becerra said in a statement. “By requiring private health plans to cover people’s at-home tests, we are further expanding Americans’ ability to get tests for free when they need them.”

The Biden administration is encouraging plans to cover the cost of tests directly, such as by establishing programs with preferred pharmacies or other retailers where consumers could pick up tests. If a health plan does that, it would be required to cover up to $12 per test if consumers purchased a test elsewhere. Consumers would need to consult with their health plan to see how it is handling reimbursements.

The guidance comes after the Biden administration shouldered criticism in recent weeks as the omicron variant surges and tests were hard to find during the holiday season.

Ceci Connolly, president and CEO of the Alliance of Community Health Plans, said the guidance “fails to address the enormous barriers: significant shipping delays, sold-out pharmacies and retailers, and the early signs of price gouging.”

Michael Bagel, ACHP’s director of public policy, said in an interview the administration should focus on issues like supply and price gouging first.

“This is a patchwork solution that isn’t actually addressing the underlying issue, which is making sure every American has access to a free test when they need it for an appropriate medical purpose, especially with omicron spreading as it is,” Bagel said.

The Biden administration has also sought to address the supply issues. Last month, the administration said it would make half a billion free at-home tests available, and officials are set to release a website where consumers can order them as soon as this week.

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