Plan to have insurers cover at-home COVID-19 tests does not solve ‘problem’ of scarcity
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Beginning Jan. 15, private health insurers and group health care plans in the United States will be required to reimburse people for the cost of up to eight over-the-counter COVID-19 tests per month, federal health officials announced.
“This is all part of our overall strategy to ramp up access to easy-to-use, at-home tests at no cost,” HHS Secretary Xavier Becerra, JD, said in a press release. “Since we took office, we have more than tripled the number of sites where people can get COVID-19 tests for free, and we’re also purchasing half a billion at-home, rapid tests to send for free to Americans who need them.”
CMS published an online guide with instructions on how people can get tests for free, saying the tests “will either be free directly at the point of sale, if your health plan provides for direct coverage, or by reimbursement if you are charged for your test.”
The Biden administration “is strongly incentivizing health plans and insurers to set up a network of convenient locations across the country such as pharmacies or retailers where people with private health coverage will be able to order online or walk in and pick up at-home over-the-counter COVID-19 tests for free, rather than going through the process of having to submit claims for reimbursement,” CMS said.
“Testing is critically important to help reduce the spread of COVID-19, as well as to quickly diagnose COVID-19 so that it can be effectively treated. [This] action further removes financial barriers and expands access to COVID-19 tests for millions of people,” CMS Administrator Chiquita Brooks-LaSure, said in a statement.
President Joe Biden announced the reimbursement proposal on Dec. 2 as part of his administration’s winter plan to fight COVID-19. Weeks later, the administration said it was purchasing 500 million at-home COVID-19 tests as part of a plan to combat the omicron variant and would begin to distribute them in January.
At the time the omicron plan was announced, experts commended the administration’s focus on providing COVID-19 tests for the public, but also criticized the timing of the effort — distributing the tests after the holidays instead of before.
Amesh A. Adalja, MD, a senior scholar at the Johns Hopkins Center for Health Security, said the reimbursement plan does not solve the “problem of the scarcity of at-home tests,” which have remained difficult for many Americans to find.
“The question is more one of supply, although the cost does play a significant role,” Adalja told Healio. “However, that cost is something that is a direct result of the development process that the FDA has stipulated for these tests by regulating them as medical diagnostic tests and not the public health tests that they are.”
The costs incurred by manufacturers of at-home COVID-19 tests are passed on to customers, said Adalja, who recommended that the tests instead be treated as tools for harm reduction — “like fentanyl test strips.”
“This whole scenario also crowds out many companies who cannot comply with the FDA’s process, so we have relatively few manufacturers that can clear the hurdles,” Adalja said.
“It is also the case that many people do not have insurance, and this will not apply to them,” he said. “If the goal is to get people tested, having them fill out forms is also not something people look forward to. It’s the out-of-pocket costs that need to fall, and I think this can be solved by allowing cheaper public health tests to flood the market.”
References:
CMS. How to get your at-home over-the-counter COVID-19 test for free. https://www.cms.gov/how-to-get-your-at-home-OTC-COVID-19-test-for-free. Last updated Jan. 10, 2022. Accessed Jan. 11, 2022.
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