Insurers will have to cover 8 home virus tests per month

WASHINGTON – Private insurers will soon have to cover the cost of eight home coronavirus tests per member per month, the Biden administration said on Monday.

According to the Department of Health and Human Services, people will be able to take the tests at “favorite” pharmacies in their health plan and other retailers at no reimbursable cost. They can also buy the tests elsewhere and file claims for reimbursement, as they often do for medical care.

“Today’s action further removes financial barriers and extends access to Covid-19 testing to millions of people,” said Chiquita Brooks-LaSure, chief of Medicare and Medicaid in the Biden administration, in a press release on the new directives.

About 150 million Americans, or about 45 percent of the population, are privately insured, mostly through their employers. Each registered dependent of the primary policyholder counts as a member.

In off-grid installations, the liability of insurers would be capped at $ 12 per test, meaning people could be responsible for any additional costs.

But if a health plan doesn’t establish a network of “preferred” retailers where patients can get covered tests upfront, it will be responsible for all claims its patients submit for their eight monthly rapid tests, with no limit to. price.

Sabrina Corlette, a research professor at the Center on Health Insurance Reforms at Georgetown University said the policy could save families hundreds of dollars a month.

“I would like to see a more comprehensive national testing policy where these tests are free for everyone, regardless of insurance status,” she said. “Will this help everyone?” No. This is certainly not the ideal way to lower the barriers to Covid testing. But it is useful.

Rapid home tests are typically sold in sets of two, costing around $ 14 to $ 34. This can be prohibitively expensive, especially when the tests are purchased in bulk.

Other countries spent more on rapid tests. In Britain, citizens can use a government website to order free rapid tests to use at home. Germany has invested hundreds of millions of dollars to create a network of 15,000 rapid test sites. Instead, the United States has focused its government procurement on vaccines and efforts to encourage uptake.

Some local governments in the United States have invested heavily in rapid testing to counter the latest wave of cases. Washington, DC, which has seen a substantial increase in virus cases, now allows residents to take four free rapid tests per day at city libraries.

The new Biden policy will not apply retroactively to home tests Americans have already purchased. Tests ordered or administered by healthcare providers will continue to be covered by insurance with no co-payments or deductibles under a law requiring insurers to fully cover tests performed in doctor’s offices, public sites and others. establishments.

The administration is working on other efforts to provide coronavirus testing to people regardless of their insurance status, including a plan to deliver 500 million free rapid tests to the homes of Americans who order them, from the end of the month.

The plan, along with the new rules for insurers announced on Monday, is part of a larger effort by the Biden administration in recent weeks to catch up with growing demand for rapid tests, as cases of the virus have exploded across the country. country with the arrival of the highly contagious variant of Omicron.

The administration also announced plans to make tens of millions of free tests available to uninsured Americans at health clinics and other sites in underserved communities. And it recently opened federally-run testing sites in hard-hit areas of the country.

Matt Eyles, president of America’s Health Insurance Plans business group, said in a statement that insurance companies “will work as quickly as possible to implement these guidelines.”

“While there will likely be some issues initially, we will work with administration to quickly resolve issues as they arise,” he said.

Testing supplies at drugstores and grocery stores nearly ran dry last month as Omicron descended, and manufacturers are rushing to restock shelves, a scramble that has prompted some experts to criticize the administration for being taken in. lacking.

Low availability could hamper the rollout of the reimbursement policy, said Lindsey Dawson, a policy analyst at the Kaiser Family Foundation who has studied the availability of rapid tests.

“If the refund exists but there are no tests to buy,” she said, “that doesn’t help an individual consumer.”

She added: “The policy could certainly stimulate demand and make the problem worse. “

Ms Dawson said prices have started to climb at some large retailers, such as Walmart. This could mean significant upfront costs for families who have to file reimbursement claims, she said.

Some health plans have also expressed concern about the potential shortage of supplies when the policy rolls out in less than a week.

“We are concerned that the policy will not address the limited supply of testing in the country and could cause additional friction for consumers as insurers roll out a program in just four days,” Kim Keck, Managing Director of Blue Cross Blue. Shield Association.

Ms. Corlette, the Georgetown researcher, pointed out several other potential issues with the new policy. The advice is not straightforward on how insurers should design reimbursement systems, so it could make the process expensive, with less user-friendly websites and more hoops to go through. There is also no deadline for reimbursement.

She added that the policy will only exist for the duration of the Covid-19 public health emergency.

Dozens of Democratic lawmakers wrote to President Biden on Sunday urging him to expand access to rapid tests, including making enough that every American takes at least one a week. They also warned that reimbursing insurance can take time and could discourage less well-off people from purchasing tests.

When Mr Biden announced the reimbursement plan in early December, it sparked skepticism from some public health experts who questioned why the United States is not buying tests in bulk and offering them inexpensively. , as European countries have done.

At the time, Jen Psaki, the White House press secretary, had rejected the idea of ​​a sprawling program to provide free tests to Americans.

But as the administration faced mounting criticism, Mr Biden announced that his administration would offer 500 million free home tests for the nation’s 330 million people, available to order through a website that should do its debut this month.

There will also be a hotline that people can call if they don’t have access to a computer or prefer to order tests over the phone, a White House official said.

The administration hastens to sign a series of test contracts with companies already in possession of tests, or with manufacturers; the first two were announced on Friday.

More deals will be announced in the coming days, officials said. Biden administration officials said they were careful not to appropriate tests that are already expected to ship to retailers like CVS and Walgreens.

It is still unclear how many tests each household will be able to order under the program and which brands will be offered through it. The FDA has cleared more than a dozen home antigen tests, some under a new fast-track review program announced by the federal government last year.

The administration’s success in getting more tests to Americans could also be complicated by preliminary research suggesting that rapid antigen tests can miss some Omicron infections even when people carry high levels of the virus. This has prompted scientists to warn against misinterpreting negative results when they show symptoms or may have been exposed to the virus. Experts continued to recommend the use of the tests.

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