Billing OTC COVID-19 Tests Brings New Struggles and Opportunities

PAAS recommends pharmacies have retrievable documentation when billing at-home COVID-19 tests through your pharmacy system. In addition, PBMs such as Prime Therapeutics and Express Scripts have communicated their billing requirements for at-home COVID-19 tests. PAAS developed the Commercially Insured Patient Request and Attestation for OTC COVID-19 Test Billing document to assist with future audits pertaining to billing a patient’s insurance for the testing supplies.

The Commercially Insured OTC COVID-19 Tests Frequently Asked Questions (FAQ) document answers many questions pharmacies may have surrounding how to go about billing the at-home tests, such as if a prescription is needed to bill for an OTC COVID-19 test or who the prescriber will be if a pharmacy initiates a prescription vs. when a pharmacy does not initiate a prescription. The FAQ document also includes a list of known authorized tests which are covered under the OTC Emergency Use Authorization (EUA), albeit not a fully comprehensive list. As stated by NCPA on February 1, 2022, there have been type 1 consumer recalls on at-home tests falsely alleging to be authorized by the FDA. When placing an order for OTC COVID-19 tests, properly vet the distributor and the product to ensure the at-home tests being ordered are an authorized FDA test.

All PAAS produced COVID-19 materials can now be conveniently located under the COVID-19 Resources page on the PAAS Portal. As additional information is released pertaining to at-home COVID test billing practices and other COVID-related topics, periodically visit the portal for the most up-to-date resources.