New Emergency Rule: At-Home COVID-19 Antigen Test Coverage 1/6/21

The Legislative Committee on Administrative Rules unanimously approved the emergency rule for at home Covid-19 antigen test coverage.


21-E21 – Department of Financial Regulation/At Home COVID-19 Antigen Test Coverage

(Received 12/7/21)  (LCAR’s 45-day review period ends 1/21/22)  Rule posted here:

Sebastian Arduengo , Assistant General Counsel, Department of Financial Regulation

  • Insured members of Cigna, MVP, BCBS (all insurers covering Vermont lives – including Medicaid) can purchase with no out-of-pocket cost at pharmacy counter or purchase at retail or online and submit for reimbursement.
  • Limit of 8 test kits per covered life per month.
  • Directed health insurers to reimburse appropriate claims retroactively to Dec. 1.
  • Effective Jan 15th – Biden was to be issuing federal guidance re: insurers and reimbursement. To date, have received no word from federal government as to what those regulations will entail. If fed rule is more broad, will supersede this emergency rule.
  • Technical issues: Issue has been supply, may have eased a bit after holidays. Continues to be biggest barrier to access.
    • Typically when insurer covers something new – follows months of coding and then testing. Compressed into a week or two for this. All kinds of glitches that have resulted in Vermonters being unable to get tests without paying upfront.
    • Many of tests authorized by FDA don’t have an entry in the database that pharmacies use to process claims. Encourage consumers to check in with insurer to see what test kits are processing. MVP and BCBS – both have lists available on their websites. We’ve included a list of 4 tests that we absolutely know will process properly: BinaxNow, QuickVue, Intelliswab, On/Go.
    • For a claim to process, it needs an ordering provider – to facilitate that process, Dr. Levine has issued a standing order prescribing the tests to any Vermonter who wants one. Linked on DoH website. Pharmacists can use it to put Dr. Levine as the ordering provider.
    • Department didn’t address other tests (molecular), followed Vermont Medicaid guidance – reduce confusion by aligning with Medicaid.
    • Guidance for consumers and insurers on DFR website.
    • Typically cost is $15-$40 and come in packs of two.
    • Publicly thanks everyone at BCBS, MVP, and Cigna for work on this.
    • LCAR approves rule unanimously.