Insurers are required to run 8 virus tests at home every month

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WASHINGTON – Private insurers will soon have to pay for eight coronavirus tests at home per member per month, the Biden administration announced on Monday.

People can get the tests at their health plan’s “preferred” pharmacies and other retailers at no cost, according to the Department of Health and Social Affairs. They can also buy the tests and submit reimbursement claims elsewhere, as they often do for medical care.

“Today’s move will remove further financial barriers and expand access to Covid-19 tests for millions of people,” said Chiquita Brooks-LaSure, the Medicare and Medicaid chief of the Biden administration, in a statement on the new guidelines.

About 150 million Americans, or 45 percent of the population, have private insurance, mostly through their employers. Every enrolled relative of the primary insured person is considered a member.

In facilities outside the network, insurers’ responsibility would be capped at $ 12 per test, meaning people could be responsible for additional costs.

However, unless a health insurance plan creates a network of “preferred” retailers where patients can get pre-tested tests, it will be responsible for any claims its patients submit for their eight monthly rapid tests with no price cap.

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

“I would like a more comprehensive national testing policy where these tests are free for everyone, regardless of insurance status,” she said. “Will it help everyone? No. It’s definitely not the ideal way to lower the barriers to Covid testing. But it’s helpful. “

Rapid home tests are typically sold in packs of two and cost between $ 14 and $ 34. This can become prohibitively expensive, especially if tests are purchased in bulk.

Other countries have spent more money on rapid tests. In the UK, citizens can order free rapid home use tests through a government website. Germany has invested hundreds of millions of dollars in building a network of 15,000 rapid test centers. The United States has instead focused on public vaccine procurement and efforts to promote their uptake.

Some local governments in the United States have invested heavily in rapid testing to counter the recent wave of cases. Washington, DC, which has seen a significant surge in virus cases, now allows residents to pick up four free rapid tests a day from libraries across the city.

The new Biden policy does not apply retrospectively to home tests that Americans have already purchased. Tests ordered or carried out by health care providers will continue to be covered without additional payment or deductible according to a law that obliges insurers to fully accept tests in medical practices, public institutions and other institutions.

The government is working on other efforts to make coronavirus tests available 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 by the end of this month.

That plan, along with new rules for insurers announced on Monday, is part of a wider effort by the Biden government in recent weeks to catch up on the skyrocketing demand for rapid tests as the country’s contagious variant of Omicron has exploded with the arrival of the highly viral cases .

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Jan. 10, 2022, 8:59 p.m. ET

The government has also announced plans to provide tens of millions of free tests to uninsured Americans in health clinics and other locations in underserved communities. And it recently opened state test sites in particularly affected regions of the country.

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

“While there are likely to be some issues early on, we will work with the administration to address issues quickly,” he said.

Supplies of tests at pharmacies and grocery stores nearly dried up last month when Omicron went down, and manufacturers are racing to replenish shelves, a scramble that has led some experts to criticize the government for getting caught on the wrong foot to become.

The low availability could hinder the introduction of the reimbursement policy, said Lindsey Dawson, a policy analyst at the Kaiser Family Foundation, which has investigated the availability of rapid tests.

“If there is a refund but there are no tests to buy,” she said, “it doesn’t help an individual consumer.”

She added: “Politicians could certainly increase demand and exacerbate the problem.”

Ms. Dawson said prices have started to rise at some large retailers like Walmart. That could mean significant up-front costs for families who need to file reimbursement claims, she said.

The Coronavirus Pandemic: Important Things You Should Know

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Around the world. In Europe, Germany is preparing for major protests against restrictions after thousands took to the streets in France and Austria and a strict new vaccination requirement came into force in Italy. In Uganda, schools reopened after the world’s longest pandemic-triggered shutdown.

Some health plans have also expressed concern about the potential lack of care if the policy is rolled out in less than a week.

“We fear that the guideline will not solve the limited number of tests in the country and cause additional friction among consumers, since the insurers set up a program in just four days,” said Kim Keck, managing director of the Blue Cross Association of the Blue Shield .

Ms. Corlette, the Georgetown researcher, pointed out several other potential issues with the new policy. The guidelines do not provide explicit guidance on how insurers should design reimbursement systems, so they could complicate the process with less user-friendly websites and more hurdles to skip through. There is also no deadline by which the reimbursement must be made.

She added that the policy will only apply 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 by making enough that every American needs at least one a week. They also warned that insurance reimbursement can be time consuming and could discourage people who are less well from buying tests.

When Mr Biden announced the reimbursement plan in early December, he met the skepticism of some public health experts who wondered why the United States is not buying tests in bulk and offering them cheaply, as European countries have.

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

However, as the government faced increasing criticism, Mr Biden announced that his government would offer 500 million free home tests to the country’s 330 million residents, which can be ordered through a website due out this month.

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

The administration endeavors to sign a number of test contracts with companies that already have tests or with manufacturers; the first two were announced on Friday.

More agreements will be announced in the coming days, officials said. Biden government officials said they are cautious about not running tests that are already supposed to be shipped to retailers like CVS and Walgreens.

It remains unclear how many tests each household can order under the program and which brands are offered through them. The FDA has approved more than a dozen antigen tests for the home, including some under a new accelerated review program the federal government announced last year.

The success of the government’s efforts to make more testing available to Americans could also be hampered by preliminary research suggesting that rapid antigen testing can miss some Omicron infections, even when people carry high levels of the virus. This has led scientists to warn against misinterpreting negative results if they have symptoms or have been exposed to the virus. Experts continue to recommend using the tests.

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