Consequences of Putting a Band-Aid on a Virus
In an effort to slow the spread of COVID-19, the Biden-Harris Administration recently required health plans to cover the cost of over-the-counter at-home tests, essentially making them “free” for the majority of Americans. While this endeavor is well-intentioned, it is not without its flaws.
The initial announcement of the new requirement from the Department of Health and Human Services (HHS) outlined the new mandate for health plans, communicating that Americans can get free at-home COVID-19 tests at their local pharmacies and retail stores.
The mandate from the Administration was given on Jan. 10th and became a requirement for health plans starting on Jan. 15, giving an incredibly short window of time for health plans to launch and initiate programs for this coverage. According to several AMCP members, the short timeframe did not allow the majority of plans sufficient time to set up a claims adjudication process nor to implement programs that allow members to obtain tests from preferred pharmacies or other entities without initial out-of-pocket costs. Instead, this rapid rollout forced plans to begin manual reimbursement processes that will be both time-consuming and costly, in essence causing daily fire drills at health plans across the country.
Another issue with the rollout was less about what it said, but rather what it didn’t say. The requirement states that “individuals with private health insurance coverage or covered by a group health plan” are entitled to reimbursement for their at-home test purchases, but it omits that the 63 million Americans covered under Medicare cannot currently take advantage of this benefit. By not addressing the health care needs of nearly 20% of our population, the new requirement may exacerbate disparities in access to care and disadvantage the population most at risk of negative COVID-19 outcomes.
As stewards of health care resources, AMCP members have also expressed concerns about the significant costs associated with this requirement. If every person covered under private insurance took full advantage of at-home tests, it would add total costs north of $180 billion to U.S. health care spending. The magnitude of this cost burden could lead to insolvency for some smaller health plans and will have a major impact on all plans in the commercial market. Patient premiums may rise significantly for years to come. In the midst of this ongoing public health crisis, we must ask if this requirement is the best use of our health care dollars. As health care professionals, we know that the most efficient and effective way to stop the spread of this virus is to increase the vaccination rate among the population.
I have spoken with many AMCP members who have expressed their concerns and frustrations about the Administration’s new requirement and its implications for health plans and our health care system. I invite you all to join the discussion on Collaborate — AMCP’s members-only online community — as we try to create consensus on the best ways to drive better patient care. I look forward to an informed debate and opportunities for more than band-aid solutions as we continue to address the COVID-19 pandemic.