Vermont becomes one of first states to require insurers to cover at-home COVID-19 tests

An emergency regulation will cover 140,000 state residents who purchase commercial insurance.

Updated: December 12, 2021 - 4:13am

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Vermont is now one of the first states to require health insurers to pay for the costs associated with at-home COVID-19 tests, Gov. Phil Scott announced.

Through an emergency regulation issued by the Department of Financial Regulation, Scott said in a news release, along with Michael Pieciak, who serves as commissioner of the Department of Financial Regulation, the rule will cover 140,000 state residents who purchase commercial insurance and requires insurance companies to pay for the costs of FDA-authorized COVID-19 antigen tests.

According to the release, it may take several weeks to implement the new rule, which will be active until March 31, 2022.

“Vermont has led the nation in testing, but we must continue to adapt and improve our strategies as we move forward,” Scott said in the release. “At-home tests will increasingly be an effective and widely used tool for managing the virus, and expanding access is a priority for my team.”

The emergency rule, according to the release, will benefit the state’s residents who utilize commercial insurance in the state’s individual, small, and large group markets, in addition to the Vermont Education Health Initiative.

According to the release, Vermont is the only state to drop out-of-pocket insurance costs for any individual requiring treatment for the virus.

Sara Teachout, corporate director of Government and Media Relations for Blue Cross Blue Shield Vermont, said the organization worked with the state on developing the rule and recommended “a least complicated way to implement it.”

Teachout said the state’s Department of Health developed a state-wide prescription for those seeking COVID-19 tests that was given to pharmacies.

“If we want to process it without member cost share, you have to run it through people’s pharmacy benefit with a prescription,” Teachout said. “You have to have a prescription in order to get it that way and you need to take the test to the pharmacist. The commissioner of the Health Department has given a blanket prescription state-wide for all pharmacies in Vermont to use. When it is processed it goes through the person’s pharmacy benefit with a prescription.”

Under the emergency rule, the at-home tests are limited to eight test kits, or not more than two tests each, for each individual covered under the plan.

If the test is purchased outside a pharmacy, according to the release, the purchaser will be mandated to submit a claim to their insurance provider for reimbursement of the cost. Reimbursement for the cost of the tests is retroactive to Dec. 1.

“Eliminating financial barriers to COVID-19 testing and treatment has been in important component of Vermont’s pandemic response,” Pieciak said in the release. “Making COVID-19 testing free and accessible helps limit the spread of the virus by identifying positive cases quickly, which is particularly important as we continue through the holiday season.”

While the state can’t extend the emergency rule to self-insured plans, according to the release, officials are urging those plans to participate. The state’s biggest self-insured pan, the University of Vermont Health Network, has indicated it will follow the rule and is encouraging other employers to do the same, the release reads.

“Blue Cross has committed to cover all COVID-19 costs until we reach the part where COVID-19 is part of the normal process,” Teachout said. “The costs comes out of member reserves. There is not a bill for vaccines, testing, and treating COVID-19.”

The member reserves, Teachout said, are accumulated through yearly premium rates.

Teachout said Blue Cross is “encouraging” self-funded insurers “to comply with the state law.

“It is their choice,” Teachout said. “If they choose to cover it, they cover it like they would any other prescriptions.”

There is no cost share for the member, she said.

Teachout said Blue Cross’s only concerns are the tests are in short supply at local pharmacies.

“It is a little difficult to obtain tests at this time,” Teachout said. “We are discoursing people from buying more tests than they need.”