Jan 18, 2022

COVID Testing for GIC Members

The following information was provided by the GIC, surrounding COVID-19 testing for GIC members. Updated 2/7/2022 to include Express Scripts information. 

COVID OTC Testing Announcement 1/14/22

On Monday, January 10, the federal government issued guidance that insurance carriers and plan sponsors (such as the GIC) will be required to cover the cost of up to 8 at-home/over-the-counter rapid test kits for COVID-19 each month, in response to the widespread impact of the Omicron variant. This coverage is effective on Saturday, January 15, 2022, and will remain in place for an unspecified period of time.
Therefore, over-the-counter COVID-19 tests will be covered by the GIC according to this guidance starting on Saturday, January 15, 2022. However, this federal guidance is unusual in nature and will take time to implement fully.
The GIC has determined that this coverage will be administered through the GIC’s pharmacy benefits managers (PBMs), Express Scripts for active plan members, and CVS Silverscript for our Medicare participants. The GIC is still working with its health plans and pharmacy benefit managers (PBM’s) to implement the processes necessary to properly administer the benefit.
What does this mean for members who may purchase one or more of these test kits in the coming days? At this time, members will pay out-of-pocket for the COVID rapid tests and subsequently seek reimbursement for the cost from their PMB. The GIC is asking all members who purchase a test to hold onto your receipt, which you will soon be able to submit, along with a forthcoming claim form.
As soon as possible, GIC members will also be able to obtain OTC test kits at no out-of-pocket cost from preferred pharmacy providers, such as CVS pharmacies or other retailers, by providing their prescription benefit cards. There will also be maximum price controls in place for reimbursement and as soon as those are determined, this will be communicated to our members.

In the meantime, there are other resources available to GIC members and other residents of Massachusetts to obtain testing, some of which are listed here:

• If you would like to find a location to schedule a free PCR or lab-performed Covid test, please use this site - mass.gov/info-details/find-a-covid-19-test 
• The state government is also working to distribute over 2 million self tests in over 100 communities that have been particularly impacted by the pandemic. For further information on the availability of these free tests, please go to - mass.gov/info-details/covid-19-self-test-distribution 
• For information on free tests distributed to community health centers by the federal government, you may go to - hrsa.gov/coronavirus/testing-supplies 

Thank you,
Group Insurance Commission
Express Scripts (Non-Medicare Members)

Non-Medicare Coverage of OTC COVID-19 Tests
Claims for at-home OTC COVID-19 testing kits will automatically process at $0 copay when checking out at in-network pharmacy counters or ordering at-home testing kits from Express Scripts Pharmacy online.
Members are eligible for up to eight at-home COVID-19 tests (up to four 2-pack testing kits) per individual at the pharmacy counter every 30 days for a $0 copay.
Non-Medicare Directions for Purchasing OTC COVID-19 Tests
  1. Take your Express Scripts ID card to a retail pharmacy in your network;
  2. Bring an at-home COVID-19 test kit to the pharmacy counter, not the regular checkout lane;
  3. Check out at the pharmacy counter and show your Express Scripts ID card. Your at-home COVID-19 test kit should automatically ring up at no cost to you. *
Non-Medicare Directions for Ordering COVID-19 Tests from Express Scripts Online
  1.  Log into your Express Scripts account at express-scripts.com;2.  Click the “Order At-home COVID-19 Tests” link;
  2. Complete the order form by selecting the name of the subscriber or dependent(s); associated with the order (Be sure to check that the mailing address and subscriber email address are correct);
  3. Acknowledgment of the terms is required before clicking the “Submit Order” button.
How to Claim Non-Medicare Reimbursement for OTC Covid-19 Tests Purchased Online or In-Store
  • Members can claim reimbursements for FDA-approved tests purchased online or in-store for at-home test kits purchased on or after Jan. 15, 2022. Reimbursements for at-home test kits will be capped at $12 per test kit (or $24 per 2-pack). **
  • A receipt of purchase is required for reimbursement.
  • To obtain additional information, submit a claim online, or to download a printable copy of the reimbursement form, please visit the COVID-19 Resource Center. You will be prompted to log in to your online Express Scripts account for specific information.
  • Printable copies of these forms and additional information on obtaining eight free COVID-19 tests (four 2-pack testing kits) from Express Scripts are available on the GIC website.
* Should any difficulties occur during in-store purchases, claims for at-home COVID-19 test kits using UPC codes from any retail or online provider can always be manually submitted.
**Please note that pharmacy purchase limits on at-home COVID-19 test kits may apply.

Only a life lived for others is a life worthwhile. - Albert Einstein
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