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Testing & treatment information

CVS Health is actively monitoring the global COVID-19 pandemic including guidance from trusted sources of clinical information such as the Centers for Disease Control (CDC) and World Health Organization (WHO). Below is information about policies and procedures that CVS Health has implemented that focus on the health and safety of our colleagues, customers, members and patients. For more information about the virus, please visit the CDC and/or WHO websites dedicated to this issue.

 

*The content below is not intended to be a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.

 

Coverage and authorization

Yes. In addition, Aetna is waiving member cost-sharing for diagnostic testing related to COVID-19. The test can be done by any authorized testing facility. This member cost-sharing waiver applies to all Commercial, Medicare and Medicaid lines of business. The policy aligns with the Families First and CARES legislation and regulations requiring all health plans to provide coverage of COVID-19 testing without cost share. The requirement also applies to self-insured plans. Per guidance from the Centers for Medicare & Medicaid Services (CMS), the Department of Labor and the Department of the Treasury, all Commercial, Medicaid and Medicare plans must cover COVID-19 serological (antibody) testing with no cost-sharing.

 

As of April 4, 2022, members with Medicare Part B can get up to eight over-the-counter COVID-19 tests each month while the COVID-19 public health emergency lasts. This includes those enrolled in a Medicare Advantage plan. The tests come at no extra cost. Members must get them from participating pharmacies and health care providers. They should check to see which ones are participating. Providers will bill Medicare. You can find a partial list of participating pharmacies at Medicare.govMembers should take their red, white and blue Medicare card when they pick up their tests.  

Aetna will cover, without cost share, diagnostic (molecular PCR or antigen) tests to determine the need for member treatment.1 Aetna’s health plans generally do not cover a test performed at the direction of a member’s employer in order to obtain or maintain employment or to perform the member’s normal work functions or for return to school or recreational activities, except as required by applicable law.

 

Aetna will cover, without cost share, serological (antibody) tests that are ordered by a physician or authorized health care professional and are medically necessary. Aetna’s health plans do not cover serological (antibody) tests that are for purposes of: return to work or school or for general health surveillance or self-surveillance or self-diagnosis, except as required by applicable law. Refer to the CDC website for the most recent guidance on antibody testing.

 

This policy for diagnostic and antibody testing applies to Commercial, Medicare and Medicaid plans.2

Yes. Prior to COVID-19, testing for infectious diseases were included in the rate for surgical procedures and that policy will continue during the COVID-19 pandemic.

Yes. If the plan provides in and out of network coverage, then the cost-sharing waiver applies to testing performed or ordered by in-network or out-of-network providers. The policy aligns with Families First and CARES Act legislation and regulations requiring all health plans to provide coverage of COVID-19 testing without cost share.

 

Members should not be charged for COVID-19 testing ordered by a provider acting within their authorized scope of care or administration of a COVID-19 vaccine. Providers can seek reimbursement for uninsured patients through the Health Resources & Services Administration (“HRSA”) for COVID-19 testing, treatment and vaccine administration. This information is available on the HRSA website.

Any test ordered by your physician is covered by your insurance plan.

 

Also, new federal guidelines allow members with private, employer-sponsored and student health commercial insurance to request reimbursement for over-the-counter COVID-19 diagnostic tests that are purchased on or after January 15, 2022 without physician’s orders1. This mandate is in effect until the end of the federal public health emergency.

In effort to expand testing capabilities, U.S. Department of Health & Human Services (DHS) authorized pharmacists to order and administer COVID-19 tests, including serology tests, that the FDA has authorized. Pharmacists, in partnership with other health care providers, are well positioned to aid COVID-19 testing expansion.

Routine testing for influenza, strep, and other respiratory infections without a COVID-19 test will be covered subject to applicable cost sharing under the member’s plan.

 

We cover, without member cost sharing, a same day office, emergency room, or other provider visit at which a COVID-19 test is ordered or administered. If as part of that visit the provider administers or orders a test for influenza, strep, or other respiratory infection, that additional testing will also be covered without member cost sharing.

Tests must be FDA authorized in accordance with the requirements of the CARES Act.

Yes, Aetna will cover tests approved, cleared or authorized by the U.S. Food and Drug Administration. Please refer to the FDA and CDC websites for the most up-to-date information. A list of approved tests is available from the U.S. Food & Drug Administration.

At this time, covered tests are not subject to frequency limitations. Subject to applicable law, Aetna may deny tests that do not meet medical necessity criteria.

Based on new federal guidelines, Aetna’s private, employer-sponsored and student health commercial insurance plans will cover up to eight over the counter (OTC) at-home COVID-19 tests per 30-day period for each person covered under your plan. This mandate is in effect until the end of the federal public health emergency. These guidelines do not apply to Medicare.
 

As of April 4, 2022, members with Medicare Part B can get up to eight over-the-counter COVID-19 tests each month while the COVID-19 public health emergency lasts. This includes those enrolled in a Medicare Advantage plan. The tests come at no extra cost. Members must get them from participating pharmacies and health care providers. They should check to see which ones are participating. Providers will bill Medicare. You can find a partial list of participating pharmacies at Medicare.gov. Members should take their red, white and blue Medicare card when they pick up their tests.

Note: Each test is counted separately even if multiple tests are sold in a single package. For example, Binax offers a package with two tests – that would count as two individual tests.  As for the eight-test maximum, a family of four covered under the same plan could be reimbursed for up to 32 tests per 30-day period.

Lab-based PCR home collection kits are not covered at this time by the OTC kit mandate.
 

Medicare covers one of these PCR kits per year at $0. The test will be sent to a lab for processing. It doesn’t need a doctor’s order.

Refer to the U.S. Food & Drug Administration on tests that are eligible for coverage.

Under the federal government’s current guidelines, tests are eligible if:
 

  • They are bought without a prescription
  • You can administer the test and read the results yourself, without the help of a health care provider

Eligible tests include single-use, cartridge-based tests (for example, Flowflex, BinaxNow or Ongo).
 

This does not apply to Medicare. Medicare covered OTC COVID tests are provided by participating providers and pharmacies. You can find a partial list of participating pharmacies at Medicare.gov. Members should take their red, white and blue Medicare card when they pick up their tests. They may also order up to two sets of four at-home tests per household by visiting COVIDtests.gov.
 

For members with Aetna pharmacy benefits, you can submit a claim for reimbursement through your Aetna® member website. Simply log on to the Aetna member website and follow the instructions.

 

If your pharmacy benefits are not with Aetna, contact your pharmacy benefits administrator for instructions.
 

Medicare will reimburse one self-order, at-home lab-processed kit per year. Medicare will reimburse for other at-home, lab-processed kits that are prescribed by a provider. Kits other than the at-home processed ones are not subject to reimbursement. Members can get OTC kits only from participating providers and pharmacies. You can find a partial list of participating pharmacies at Medicare.govMembers should take their red, white and blue Medicare card when they pick up tests. They may also order up to two sets of four at-home tests per household by visiting COVIDtests.gov.

For members with CVS Caremark pharmacy benefits or whose employer covers these tests under medical benefits:

 

  • You should expect a response within 30 days. If your reimbursement request is approved, a check will be mailed to you.

For members with 3rd party PBM:

 

  • Your pharmacy plan should be able to provide that information.

Members with CVS Caremark & members whose plan sponsor is covering under medical.

When you submit your claim, you’ll need to include:

 

  • Who the tests are for (self or dependent)
  • The number and type of tests purchased
  • Date of purchase
  • Price of purchase
  • A copy of your receipt

You’ll also be asked to attest that the OTC kit is for personal use only, and not for employment, school, recreational or travel purposes.

 

For members with 3rd party pharmacy

  • Your pharmacy plan should be able to provide that information. (Offer to transfer member to their PBM’s customer service team.)

If you have private, employer-sponsored or student health commercial insurance you’re eligible to get reimbursed for over-the-counter at-home COVID kits. You are not eligible if you have Medicare, Medicare Supplement, Medicaid, or voluntary insurance.

  • Aetna will cover up to eight (8) over the counter (OTC) at-home COVID-19 tests per 30-day period for each person covered under your plan.
  • Note: Each test is counted separately even if multiple tests are sold in a single package. (For example, BinaxNOW offers a package with two tests included – that would count as two individual tests).
  • Tests must be approved, cleared or authorized by the U.S. Food and Drug Administration.
  • You can only get reimbursed for tests purchased on January 15, 2022 or later.
  • These tests don’t require an order from your physician to qualify for reimbursement, although tests ordered by a provider aren’t subject to the frequency limit.
  • Tests must be used to diagnose a potential COVID-19 infection. Tests used for employment, school or recreational purposes are not eligible for reimbursement unless required by state law.

Aetna Medicare plans do not reimburse for OTC COVID-19 tests.  Aetna Medicare members can obtain OTC COVID-19 tests from participating providers and pharmacies, but will not be reimbursed for self-purchased tests. You can find a partial list of participating pharmacies at Medicare.gov. Members should take their red, white and blue Medicare card when they pick up tests. They may also order up to two sets of four at-home tests per household by visiting COVIDtests.gov.

Coverage is in effect, per the mandate, until the end of the federal public health emergency.

Your employer or health plan will have the best information on how to buy OTC COVID-19 tests that will be covered.

Some pharmacies may not be able to process claims for OTC COVID-19 tests at the pharmacy counter. If this happens, you can pay for the test, then submit a request for reimbursement.

 

COVID-19 drive-thru testing at CVS Pharmacy locations

CVS Health is uniquely positioned to play a vital role in supporting local communities and the overall health care system in addressing the COVID-19 pandemic. Our ability to coordinate the availability of COVID-19 testing bolsters states’ efforts to manage the spread of the virus.

 

In March, CVS Health opened a pilot drive-through COVID-19 test site in a parking lot at a CVS Pharmacy store in Shrewsbury, MA. This pilot provided the company with a number of key learnings, which helped inform the company’s ability to improve on and maximize drive-through testing for consumers.

 

In April, CVS Health joined forces with the U. S. Department of Health and Human Services and state governments in Connecticut, Georgia, Massachusetts, Michigan and Rhode Island to help increase access to rapid COVID-19 testing at large-scale sites in publicly accessible areas. Each site operated seven days a week, providing results to patients on-site, through the end of June.

 

Since then, CVS Health has continued to expand access to COVID-19 testing, establishing testing sites at more than 4,800 CVS Pharmacy locations across the country, including nearly 1,000 of which provide rapid-result testing.

For more information on test site locations in a specific state, please visit CVS.com.

Our pharmacies and MinuteClinics are uniquely positioned to help address the pandemic and protect people’s health. Building on the company’s comprehensive efforts to help slow the spread of the virus, we can bring safe and effective testing options closer to home and help increase access to testing options for even more individuals. This allows us to continue to help slow the spread of the virus.

Testing will not be available at all CVS Pharmacy locations. CVS Pharmacy, HealthHUB and MinuteClinic will continue to serve customers and patients.

 

CVS Health currently has more than 4,800 locations across the country offering COVID-19 testing. Through this effort we are hoping to provide access in areas of the country that need additional testing and are selecting CVS Pharmacy locations with this criteria in mind.

Yes, patients must register in advance at CVS.com to schedule an appointment. Patients will need to pre-register, provide their insurance information as appropriate and verify their eligibility for testing. Once they have registered, the patient will be provided with an appointment window for up to seven days in advance.

Patient samples collected at our COVID-19 drive-thru testing sites are sent offsite to independent, third-party labs who are responsible for processing and delivering the results, which we then communicate to patients. On average, the test results are typically available within 1-2 days, but may take longer due to local surges in COVID-19.

Children age 3 years and older are now eligible for testing at all of our COVID-19 drive-thru and rapid-result testing sites located at select CVS Pharmacy locations, effective March 5, 2021. A parent or legal guardian must complete the on-line registration for all minor patients, and patients 3 to 15 years of age must be accompanied by a parent or legal guardian when they come to be tested.

Parents or guardians seeking testing for children under the age of 10 (or the age of 5 for rapid-result testing) should consult with a pediatrician to identify appropriate testing options.

 

Treatment

For all Aetna-insured Commercial plans, Aetna waived member cost-sharing for inpatient admissions for treatment of COVID-19 or health complications associated with COVID-19 through February 28, 2021. This waiver may remain in place in states where mandated. Self-insured plan sponsors offered this waiver at their discretion.

Aetna will cover treatment of COVID-19 for our Medicare Advantage members. Please note that copays, deductibles and coinsurance will apply according to the member’s benefit plan.

 

Protecting yourself

The CDC recommends that anyone: who has symptoms of COVID-19 who has been in close contact with a person known to have COVID-19: or who lives in or has recently traveled from an area with ongoing spread of COVID-19, should contact their health care provider and be tested.

 

We’re here to support you Find out how

CDC info

Get the latest updates on every aspect of the pandemic.

 

Visit the CDC

State resources

Get vaccine news, testing info and updated case counts.

 

Find state resources

CVS Health

Access trusted resources about COVID-19, including vaccine updates.

 

Visit CVS Health

The information contained in this FAQ is subject to change at the discretion of CVS at any time, for any reason and without advanced notice.

 

1Aetna will follow all federal and state mandates for insured plans, as required.

2Disclaimer: Regulations regarding testing for Aetna Medicaid members vary by state and, in some cases, may change in light of the current situation. Providers are encouraged to call their provider services representative for additional information.

Legal notices

Aetna is the brand name used for products and services provided by one or more of the Aetna group of companies, including Aetna Life Insurance Company and its affiliates (Aetna).

Health benefits and health insurance plans contain exclusions and limitations.

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