Providing Affordable and Seamless COVID-19 Testing

Covering COVID-19 over-the-counter tests at the point of sale ensures easy and affordable access to limit the spread of the disease.

Since the onset of the pandemic, Evernorth has developed innovative solutions and resources built on a foundation of data and clinical expertise to help keep members healthy and safe.

With the Federal mandate requiring insurers to cover over-the-counter (OTC) COVID-19 tests in effect since January 15, Express Scripts is committed to responding to new market dynamics and ensuring members have greater access to testing.  

Announced last year, Express Scripts PBM COVID-19 Over-the-Counter Testing Kit Solution provided industry-first point of sale coverage for eight tests per member per month. These kits are available for members of participating plans with no up-front cost at anyin-network pharmacy, because, for some individuals, requiring upfront payment may keep OTC COVID-19 tests out of reach.

We believe the simplest experience for members is the best one.

Insurers can offer their members three options for obtaining these tests at no cost:

  1. Reimbursement: A member visits a retail pharmacy and purchases an OTC test. Then, they submit a claim to their health insurer for full reimbursement of the cost of the test.
  2. Point of sale: A member in a participating plan visits a retail pharmacy and shows their member ID card at the pharmacy counter. The OTC test is adjudicated at the point of sale, requiring no upfront cost from the member.
  3. Home delivery: Members of participating plans can order up to eight at-home COVID-19 tests every 30 days from Express Scripts® Pharmacy by logging into their account and placing an order. These tests will be shipped to their home at no cost.

In addition, Express Scripts has also recently  partnered with CVS Pharmacy and Rite Aid to launch a new limited network COVID-19 Over-the-Counter Testing Kit Solution, which will provide a better member experience at the point of sale. Through this partnership, members can pre-order test kits and pick them up at a retail store, which ensures the kits are in stock. As always, these test kits are adjudicated at the pharmacy counter, which means no up-front cost.

OTC COVID-19 testing not only is a simpler experience for members, but ultimately results in lower medical cost for plans. A $12 test – or $96 for eight tests per month – is significantly less than a PCR lab test, which typically also requires an office visit, incurring additional costs.

While we can’t test our way out of this pandemic, we believe easy and affordable access to COVID-19 testing can make a real difference in knowing your status quickly and limiting spread of the virus.

See how our solutions can help
Express Scripts PBM COVID-19 Over-the-Counter Testing Kit Solution
The COVID-19 over the counter (OTC) Testing Kit Network allows OTC rapid antigen at-home tests to be processed through the pharmacy benefit when it’s added to your covered drug list. We’ve designed the solution to meet mandate requirements.


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