Effective January 15, 2022, all three medical options (PPO, EPO, and HDHP) cover over-the-counter home tests for COVID-19.
As of January 15, 2022, the Medical Plan covers up to eight over-the-counter (OTC) home COVID-19 tests for a covered member in a 30-day period, provided the test is approved by the U.S. Food and Drug Administration (FDA). Those enrolled in the PPO, EPO, or HDHP can get these tests at Express Scripts pharmacies or through Express Scripts Pharmacy home delivery service, and no copay, deductible, or coinsurance will apply.
In addition, under a Medicare initiative effective April 4, 2022, retired members enrolled in the Medicare Supplement Plan can get up to eight OTC home COVID-19 tests each calendar month at no cost to the member.
Members enrolled in Triple-S also have no-cost coverage for OTC home COVID-19 tests, but the reimbursement process is different.
The plan does not cover COVID-19 testing for employment purposes; for example, an employer screens all employees before they return to the workplace.
Simply present your prescription drug ID card when buying FDA-approved OTC home COVID-19 tests at the pharmacy counter of a participating Express Scripts pharmacy, and you won't be charged a copay. You and your covered family members can each get up to eight OTC tests in a 30-day period for $0 copay. If a package includes two or more tests, each individual test will count toward the eight-test maximum. In other words, if you buy two packages that each contain two tests, it counts as four tests.
$0 copay tests through Medicare
If you are enrolled in the Medicare Supplement Plan, you can get OTC home COVID-19 tests through Medicare for $0 copay starting April 4, 2022. Just present your red, white, and blue Medicare card at any participating pharmacy (instead of your Express Scripts prescription drug ID card) and the pharmacy will bill Medicare on your behalf. You can get up to eight OTC home COVID-19 tests in a calendar month for $0 copay. Read more about the Medicare initiative.
You can also use Express Scripts Pharmacy home delivery service to get your eight tests with no copay. To order your tests for home delivery, log on to the Express Scripts website and click Order At-home COVID-19 Tests under Quick links on the homepage. If ordering through home delivery, you will receive eight OTC home COVID-19 tests. You cannot order fewer than eight tests through mail order. Therefore, if you get tests at a participating pharmacy, you should not use home delivery during the same 30-day period.
Due to potential limited supplies, some tests ordered through home delivery may take up to two weeks to arrive. For more information, visit the Express Scripts COVID-19 Resources Center.
If you purchased an FDA-approved OTC home COVID-19 test from January 15 through January 31, 2022, you can submit your receipt(s) showing the purchase date and universal product code (UPC) found on the test box to Express Scripts for reimbursement.
Note: While the Medical Plan covers up to eight OTC home COVID-19 tests per member in a 30-day period, keep in mind that these tests have a limited shelf life, so you should only purchase what you need. Being thoughtful about this number also helps to ensure access for everyone.
In some cases, you may have to pay out of pocket for FDA-approved OTC home COVID-19 tests and submit a request for reimbursement from Express Scripts. Situations where you would pay out of pocket include the following:
You (and each covered family member) can be reimbursed for up to $12 per test, subject to the eight-test limit in a 30-day period.
To file for reimbursement by mail
Attn: Commercial Claims
P.O. Box 14711
Lexington, KY 40612-4711
Important: You can submit requests for reimbursement online only if you have national drug code (NDC) number for the test(s) purchased (typically found on your pharmacy receipt). If you do not have this number, you will need to submit your request by mail.
To file for reimbursement online
Note: If you are enrolled in the PPO, EPO, or HDHP and need help filing a request for reimbursement from Express Scripts or ordering OTC home COVID-19 tests through home delivery, call Quantum Health at 855-497-1237 and a Care Coordinator will assist you.