Over-the-Counter (OTC) Test Kits

COVID-19 Over-the-Counter (OTC) Test Kit Information

Medicare

At this time, Medicare members are encouraged to access testing through their doctor’s office, laboratories or community testing sites. We are not required to cover the Over-the-Counter COVID test kits. As a result we are not reimbursing members for purchased OTC COVID-19 test kits. Medicare members will have the ability to utilize their over-the-counter (OTC) allowance to purchase OTC COVID-19 tests. Medicare members will also have the ability to order COVID-19 test kits online through our partner NationsOTC. OTC COVID-19 test kits will be available for ordering soon and kits will be delivered within 48 hours. Members should have their member ID number handy when ordering. Please check back here for continued updates and links for ordering.

Medicaid

At this time, Medicaid members are covered for on-site COVID-19 testing. We are expecting further guidance from the state on how Medicaid members will be covered for OTC COVID-19 tests.

If you are enrolled in a Medicaid plan: Effective February 7, 2022, FDA approved COVID-19 OTC Antigen and Molecular Home Test kits from a network pharmacy are covered with no cost to the member. Test kits must have a national drug code (NDC) for the network pharmacy to submit a claim to Virginia Premier. Some test kits may have age restrictions. A prescription may be required for the network pharmacy to submit a claim; members should contact their pharmacy or provider to obtain the necessary prescription when required. Each member will have coverage of two (2) tests per day with a maximum of eight (8) tests every 30 days. (Please note that many tests are packaged in pairs, so this may mean four (4) kits of two tests per member.)