White House to Implement Policy to Cover the Cost of COVID-19 Testing

WASHINGTON — President Joe Biden recently implemented new actions to protect Americans against COVID-19 variants this winter, including a new policy beginning Jan. 15 to expand at-home testing.

“More than 150 million Americans with private insurance, who are now able to get tests covered in physician offices, pharmacies, and clinics with no cost sharing, will also be able to get at-home tests reimbursed by insurance. In addition to more than 20,000 federally-supported free testing sites across the U.S., at-home tests will be distributed through key community sites, such as health centers and rural clinics,” said White House officials in a fact sheet provided to reporters last week.

Biden’s plan may experience complications according to health policy experts who say the burden will fall on the consumer to request reimbursement for testing.

“The policy to have private insurance cover the tests through a reimbursement mechanism isn’t without barriers. First, you have to have private insurance. Second, you have to know the policy exists. Third, you have to be able to front the cost of the test that ranges from about $14 for two tests to about $40 for one test. It’s definitely not a [policy] that will totally eliminate cost barriers, but it can help to address cost barriers for some people,” said Lindsey Dawson, an associate director at the Kaiser Family Foundation who has been studying the availability of rapid COVID-19 tests, during a phone call with The Well News. 

According to Dawson, the White House said consumers will need to hold onto the receipt after purchasing an at-home test and submit it to their insurance company for reimbursement, although the official guidance will need to clear up if reimbursement rates will vary among insurers. 

In a policy brief completed by Dawson and her colleague, she found that the initial National Strategy for COVID-19, which was released on Jan. 22, 2021, underscored the importance of rapid testing particularly when it came to safely reopening schools, business and travel. 

Dawson said the Biden administration now expects to double the rapid test capacity by the end of 2021 from 100 million tests per month to 200 million, rising to 300 million by February 2022 by streamlining efforts of the FDA’s regulatory pathway to bring them into the US market.

There are currently 16 authorized home diagnostic tests which consist of 12 antigen tests which accurately diagnose negative cases, and four molecular polymerase chain reaction, or PCR tests to detect virus’ genetic material. 

The Rapid Acceleration of Diagnostics initiative, known as RADx, is a collaboration of the National Institutes of Health, FDA, Centers for Disease Control and Prevention and other Health and Human Services experts. It is designed to identify manufacturers of high-quality tests and encourage them to increase options for consumers, overall supply, and potentially lower costs as announced by the HHS on Oct. 25, 2021.

“The administration has said that costs cannot be recouped retroactively, so if someone buys the test today there’s a chance the administration won’t have to cover it in the future,” said Dawson. 

There is also confusion as to when the payment for tests should be reimbursed by insurers, as federal guidance indicates that at-home tests should only be required to be covered if, “ordered by an attending health care provider who determined the test is medically appropriate.”

“Up until [Monday], the White House guidance on at-home testing focused on people who were asymptomatic or who had been in close contact with someone with COVID-19. [On Monday], the page on self-testing was revised, and that newly encourages testing before people gather with individuals outside their household as part of those reduction strategies,’ said Dawson. 

While on a briefing call this week, Dawson said the director of the CDC received a question as to when and how often an individual should be tested, and the director repeatedly used a situation where a large group of people might gather. 

So far, the White House has indicated that it will not provide reimbursement for testing for an individual who is testing for travel purposes or testing for employment in place of a vaccine mandate. 

“The administration is interested in having home testing be a key piece in COVID response alongside vaccination and masking, and we will have to watch carefully whether this policy change is enough to address the cost barriers of getting these tests,” said Dawson.

“This policy does target people with private insurance. So, if you are uninsured or unable to pay the upfront costs, or have Medicare or Medicaid, the policy wouldn’t necessarily be a way for you to access tests,” said Dawson.

Dawson said in addition to the 25 million tests ordered by the White House, the Biden administration has ordered an additional 25 million to be distributed across hundreds of community testing sites.

“The White House said they would make them available starting this month, and this should start to hit community sites where people are vulnerable and need to get care… but we will have to see if there is the demand there to require more tests at these sites,” said Dawson.

Although there is no current federal website for understanding the differences in selecting an at-home test, there is a HHS community-based testing website where an individual can select a state and search for free testing sites. 

There is also no national system for reporting at-home test results, but some places like Washington, D.C.,  have developed an online portal to self-report at-home test results. However, it is still up to the consumer to seek care if they retrieve a positive test result.

“There isn’t a guarantee that if someone tests positive with a home test that they will seek care, but we do know some people will get that confirmatory test and it will halt onward transmission,” said Dawson.  

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