Biden Pledges A Billion COVID-19 Tests, Announces Plan Requiring Private Insurers To Pay For At-Home Diagnostics

As pressure builds on US President Joe Biden to do more to ramp up COVID-19 testing, the administration has taken steps it says will go a long way toward finally ending the pandemic.

Speaking from the White House Thursday, Biden said his administration has purchased an additional 500 million over-the-counter at-home tests to be distributed free to any American that wants one. These tests will be available via a website the administration says will be up and running soon. This latest purchase is on top of an initial 500 million tests the administration bought prior to the December holiday season.

“I know we’re all frustrated as we enter this new year,” Biden said on 13 January. “The Omicron variant is causing millions of cases and record hospitalizations.”

The president also referred to the pandemic as the “pandemic of the unvaccinated,” and said that even though the vaccinated could still become infected the chances of no symptoms or mild symptoms in the vaccinated remained overwhelmingly high, whereas the unvaccinated were 17 times more likely to end up in the hospital, leaving “little room in hospitals” for non-COVID-19 patients.

Biden again urged all Americans to get vaccinated. “Personal choice impacts us all,” he said.

The president also announced on Thursday his administration’s plan to send free face masks to all Americans. “I know for some Americans a mask is not always affordable or convenient to get,” Biden said. Details of that plan, the president said, are forthcoming.

The administration further announced this week it will increase the number of COVID-19 tests available to schools by 10 million per month – including 5 million free rapid tests to schools each month – to help K-12 schools implement screenings in accordance with guidelines from the Centers for Disease Control and Prevention, and 5 million additional lab-based PCR tests for schools to perform individual and pooled testing in classrooms nationwide.

The additional testing will be delivered through the Department of Health and Human Services’ Operation Expanded Testing program, which is funded by the American Rescue Plan, the massive coronavirus funding legislation signed into law by Biden last year.

Coverage Mandate

The Biden administration is also requiring, starting on 15 January, that all private and group insurance plans cover COVID-19 OTC tests at no cost – it doesn’t matter if the insurance was purchased privately or is through an employer.

The requirement applies to any OTC test authorized, cleared or approved by the Food and Drug Administration. This means most Americans will be able to pick up a test at their local pharmacy, or order one online, with the cost of the test either being paid for at the point of sale or reimbursed through submitting a claim.

The Biden administration, however, says it wants insurance companies to set up networks of convenient locations where consumers can purchase the tests without any upfront charges or having to submit a reimbursement claim. The incentive for plans to set up these networks is that it then allows them to limit the per-test reimbursement amount for retailers outside of that network.

“Insurers will likely share with their members a list of pharmacies and retailers where they can purchase home COVID tests and not be charged." – Michael Giusti 

As part of the new requirement, insurance companies must reimburse up to $12 per test and cover up to eight tests per person. A family of four, for example, will be eligible to get 32 tests a month.

But due to the short notice, insurers might not be able to set up those networks by the time the plan goes into effect, said Michael Giusti, an analyst for insuranceQuotes.com.

“In the future, similar to providing a list of in-network medical offices, insurers will likely share with their members a list of pharmacies and retailers where they can purchase home COVID tests and not be charged,” Giusti said.

Also, with most Americans getting their insurance through their job, the new plan will likely result in increased costs for employers, according to Stephen Lucke, a partner at the law firm Dorsey and Whitney, and co-chair of the Health Litigation Group. “Employers that require testing as an alternative to vaccination should be attentive in monitoring OTC COVID testing claims and coordinate with their service providers about possible steps that might mitigate the risk of improper claims,” he said.

Currently, reimbursement for COVID-19 tests is only required for those administered by a medical provider and does not include at-home tests.