Over-the-Counter COVID-19 Tests
The Biden administration on Jan.10 announced that starting Jan.15, 2022, commercial insurance companies and group health plans will be required to provide coverage for authorized over-the-counter (OTC) COVID at-home testing products at a $0 cost share for members for up to eight individual tests per member each month.
Starting January 15, BCBSWY members can go online, to a pharmacy, or retail store to purchase an at-home over-the-counter COVID-19 diagnostic test authorized by the U.S. Food and Drug Administration (FDA) either through reimbursement or free of charge through an in-network pharmacy location.
BCBSWY highly encourages members to purchase a test directly from an in-network pharmacy counter to ensure the claim will be filed electronically.
We recognize that OTC tests are currently limited, and members may not be able to find a test at a pharmacy. For non-pharmacy providers, if you have OTC at-home tests available that you would like to offer to your patients, please collect payment at the time of service for the test. Claims submitted for OTC at-home tests to BCBSWY on behalf of a patient will be denied.
To be reimbursed, patients will be responsible for submitting a paper claim to BCBSWY, these will process through their pharmacy benefits. Please make sure they have an itemized receipt. Reimbursement for individual tests is not to exceed $12 which is the same reimbursement paid to BCBSWY participating pharmacies. Any costs above $12 will be an out-of-pocket expense for the member.
COVID-19 lab-based tests ordered by a physician or completed in a medical office will continue to be covered by medical claims.
For more details on OTC at-home tests, please direct BCBSWY members to: BCBSWY.com/covid19
