Pharmacy Benefits to Pay for Over The Counter (OTC) COVID-19 Test Kits!
Starting January 15th, the Families First Coronavirus Response Act (“FFCRA”) requires that Over the Counter (OTC) COVID-19 Tests are to be covered by health plans. To support these efforts, Southern Scripts has established a Direct Coverage Program for its members.
What you need to know:
The Biden-Harris Administration is purchasing 500 million over-the-counter at-home tests to be distributed for free to all Americans who want them, four test kits per household, starting in January 2022.
Click of the following link to order your free test kits from the United States Postal Services: COVID Home Tests | USPS
- We will also support reimbursement of OTC COVID-19 Tests purchased outside of the Direct Coverage Program through our standard manual claims process:
- To complete an online form:
- Visit https://portal.southernscripts.net/member/claim?direct=true
- Complete the form
- Upload the receipt for the OTC COVID-19 Tests
- To complete an online form:
- Members will have the ability to present their pharmacy identification card to a contracted network Network pharmacies can then submit a claim for over the counter COVID-19 tests through their point-of-sale system, which will result in a paid claim no cost to members.
Please note that this does not a) ensure a network pharmacy has tests available; and/or b) ensure the pharmacy has implemented operations to support claims submission; therefore:
OR contact our 24/7/365 Customer Service team for assistance at (800) 710-9341 or email questions to firstname.lastname@example.org.
Here are a few bullet points with additional information:
- This coverage is only for OTC COVID-19 Tests and is separate from coverage requirements for COVID-19 tests ordered by a healthcare provider
- Coverage cannot have any cost-sharing, prior authorization, and/or medical management
- If plans do set up Direct Coverage, then reimbursement to members who pay out of pocket may be limited by the plan to $12 per. Note the $12 reimbursement ONLY applies if the plan has a Direct Coverage option for members
- Members are not required to use the pharmacy network/retail providers under the Direct Coverage If the member elects a non- network pharmacy/retailer, the member may receive limited amount of reimbursement of $12 per test. Members will need to save receipt(s) and complete an online manual claim form in order to receive reimbursement
- Plans must cover no less than 8 tests per 30-day period and cannot limit a member to a smaller number of tests over a shorter period (i.e., 4 tests per 15-day period) without a prescription from a prescribing
- Plans must cover all OTC tests written by a prescribing physician that may exceed 8 tests per a 30-day period
More information and member specific communication materials will be forthcoming. For detailed information about OTC COVID-19 Test coverage, we suggest reviewing the FAQs https://www.cms.gov/files/document/FFCRA-Part-42- FAQs.pdf.