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Prescription Reimbursement Claim Form

The Biden administration recently 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. There is a zero cost share for members for up to 8 individual tests per member each month.

Additional information is included below.

Beginning Jan. 15, pharmacies will be able to bill at-home, self-read COVID-19 tests to your insurance at the point of sale, resulting in no cost to you.

If you buy a test from a retailer, other than a pharmacy, the test will need to be purchased and then submitted to the insurance for reimbursement of up to $12 per test. Home test kits for required employment testing or for resale are not eligible to be submitted to your insurance for reimbursement.

Check your state health department website for other free testing options and locations.

Your health plan has arranged for convenience coverage, with no upfront costs to you, when tests are received and billed to your insurance through a pharmacy.

The current list of preferred pharmacies is located on your health plan's website.

No, you do not need a prescription for the over-the-counter COVID-19 test.

As of February 2022, the list of covered over-the-counter (OTC) at-home COVID-19 tests available for no cost is below. The list of approved tests is subject to change. See your health plan's website for the most current list of approved tests.

NDC Brand Name Tests Per Package GPI Name
56964000000 Ellume COVID-19 Home Test 1 COVID-19 At-Home Antigen Test Kit
11877001140 Binaxnow COVID-19 AG Card Home Test 2 COVID-19 At-Home Antigen Test Kit
50021086001 Ellume COVID-19 Home Test 1 COVID-19 At-Home Antigen Test Kit
08337000158 Inteliswab COVID-19 Rapid Test 2 COVID-19 At-Home Antigen Test Kit
14613033968 Quickvue At-Home COVID-19 Test 5 COVID-19 At-Home Antigen Test Kit
14613033972 Quickvue At-Home COVID-19 Test 2 COVID-19 At-Home Antigen Test Kit
11877001133 Binaxnow COVID-19 AG Card Home Test 6 COVID-19 At-Home Antigen Test Kit
60006019166 On/Go COVID-19 Antigen Self-Test 2 COVID-19 At-Home Antigen Test Kit
82607066026 Flowflex Kit Home Test 1 COVID-19 At-Home Antigen Test Kit

Check your state health department website for other free testing options and locations. More information on free test kits is available online. 

Tests are included if they are used at home, with results read at home and do not require a prescription order or to be read by a medical lab.

Tests for prescribed tests and those that must be read by a lab are not processed through your pharmacy benefit. Please contact your health plan for questions on coverage for these tests.

No, only over-the-counter COVID-19 at-home test kits on the coverage are eligible for reimbursement through your pharmacy coverage.

  • For non-contracted pharmacies and local and online retailers, you will be reimbursed at 100% of your costs up to a maximum of $12 per individual test for up to eight over-the-counter Covid-19 test kits per 30 days.

  • Depending on the product, there may be more than one test kit in a box. For example, if there are two test kits in one box, the reimbursement would be up to $24.

  • When using a contracted pharmacy, please go to the pharmacy counter to have a claim submitted for no cost.

  • When using a contracted pharmacy, you will be reimbursed the pharmacy's contracted rate or the maximum of $12 per individual test.

  • Home test kits for required employment testing or for resale are not eligible to be submitted to your insurance for reimbursement.

A drug claim form would need to be filled out along with the receipt from the retailer where the over-the-counter COVID-19 test kit was purchased and sent back to the address located on the form.

Through the insurance you can receive reimbursement for up to eight over-the-counter Covid-19 test kits per 30 days per member. Home test kits for required employment testing or for resale are not eligible to be submitted to your insurance for reimbursement.

The standard turnaround time for reimbursement is 21 days. Depending on volume, additional time may be needed to process your reimbursement request. Purchasing the tests through your pharmacy will eliminate the need for reimbursement.

No, anything purchased prior to Jan. 15, 2022, would not be covered for reimbursement.

Yes, Medicare is paying for the over-the-counter tests.

Medicaid plans would follow their state guidelines due to federal direction in August 2021.