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Coverage of over the counter COVID-19 test kits through pharmacy benefits

Someone checks the result from an at-home COVID-19 test

Access to COVID-19 testing is critically important as we work to limit the spread of COVID-19 variants. AmeriHealth Administrators is implementing the Biden administration’s over-the-counter (OTC) testing program finalized in January.

Since they became available, AmeriHealth Administrators covered testing to diagnose a COVID‑19 infection when ordered by a health care professional. Now, we are covering up to eight OTC at‑home tests per member per calendar month when the tests are for personal use to diagnose a COVID‑19 infection, in alignment with the federal requirement.

AmeriHealth Administrators will administer this coverage for clients that have pharmacy coverage with us through FutureScripts/Optum. This coverage will be available through the end of the federal Public Health Emergency.

Members of Group Health Plans administered through AmeriHealth Administrators with  FutureScripts (OptumRx) can access this coverage in three ways:

  • Point of Sale: Members can visit any Walmart, Sam’s Club, or Rite Aid location, get an OTC COVID-19 test kit off the shelf, and check out at the pharmacy counter with $0 out-of-pocket costs. Members must present their member ID card and ask to have the OTC test submitted to OptumRx.
  • Order online: You can order an OTC COVID test from OptumRx and have it sent to your home.
  • Member Reimbursement: If members purchased an OTC COVID-19 test on or after January 15, 2022, they can submit for a reimbursement of up to $12 per test. Members should complete the OptumRx Over-the-Counter Test Reimbursement Form and include their receipts. Members need to submit a separate claim form for each family member.

The Biden administration has also set up a website where people can order four free COVID-19 rapid tests per household. These tests can be ordered by visiting covidtests.gov.

In addition, AmeriHealth Administrators continues to cover FDA-approved COVID-19 diagnostic tests, such as PCR tests, with no cost share for any member when ordered or administered by a health care provider following an individualized clinical assessment. AmeriHealth Administrators does not cover tests that are needed for return to work, a condition of employment, return to school, or travel.

Additional information about COVID-19 testing and vaccines can be found on our COVID-19 website.