February 8, 2022
Following a CMS announcement on over-the-counter tests, ACHP responds in HealthPayerIntelligence to this important improvement in testing guidance.
CMS released guidance around the over-the-counter coronavirus testing requirement, providing greater clarity regarding what kinds of direct-to-consumer access mechanisms fall under compliance and answering questions related to testing shortages and fraud.
The guidance explained that the requirement to provide adequate access to over-the-counter coronavirus tests entails establishing an in-person method of receiving the tests and a direct-to-consumer shipping option.
One of the primary problems that payers and consumers faced with this rule was that coronavirus tests are limited in supply. An eHealth survey found that almost three out of ten consumers experienced challenges accessing a coronavirus test in the past six months.
CMS explained that payers would not be penalized for not providing access to over-the-counter coronavirus tests if their supply is limited due to the shortage. Payers who face this scenario can continue restricting their coronavirus testing coverage to $12 per test.
Major payer organizations have responded positively to the agency’s decision to require Medicare to cover at-home coronavirus tests.
“Medicare coverage of over-the-counter COVID tests is a critical step in ensuring timely, equitable and affordable access — no matter where you live, how old you are or whether you have private health insurance. Our seniors and the most vulnerable deserve this important and potentially life-saving benefit” — Ceci Connolly, Alliance of Community Health Plans