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Prescription benefit now covers over-the-counter COVID-19 tests

On Jan. 10, the Biden Administration announced that under the Families First Coronavirus Response Act (FFCRA), group health plans will be required to cover the cost of at-home, over-the-counter, FDA-approved COVID-19 tests. Beginning Jan. 15, 2022, enrolled employees may purchase OTC COVID-19 tests through Vanderbilt’s Pharmacy plan.  

Our prescription benefit vendor, Navitus, recommends that employees get OTC COVID-19 test kits at the pharmacy counter to ensure that the kits are processed properly at the point of sale. The over-the-counter COVID-19 tests will be covered at a reimbursement rate of up to $12 per test, with a quantity limit of eight tests per covered individual every 30 days for test kits obtained without a health care provider’s involvement or prescription. Please note, this quantity limit does not apply to test kits ordered by a health care provider. 

Examples of FDA authorized OTC COVID-19 tests include, but are not limited to: 

  • BinaxNOW COVID-19 Antigen Self Test 
  • CareStart COVID-19 Antigen Home Test 
  • Ellume COVID-19 Home Test 
  • Flowflex COVID-19 Antigen Home Test 
  • iHealth COVID-19 Antigen Rapid Test 
  • InteliSwab COVID-19 Rapid Test 
  • QuickVue At-Home OTC COVID-19 Test 

To find an in-network pharmacy, visit Navitus.com. 

If you pay out of pocket, please submit the COVID-19 OTC Test Claim Form that is available for download at navitus.com/members for reimbursement of your costs. 

For more information, read Navitus’ Frequently Asked Questions.  

Not covered under Vanderbilt’s CDHP or PPO Plan? 

For Medicare members, COVID-19 tests are covered under Medicare Part B. State Medicaid and CHIP programs are required to cover FDA-authorized at-home tests. Members with Medicaid or CHIP coverage should contact their state agency, as coverage rules may vary by state. For Aetna International Plan members, tests are covered unless claims are incurred outside the United States.  

On-campus Health and Safety Protocols 

At-home OTC COVID-19 tests cannot be used to replace on-campus testing. If you have been notified that you must be tested, please still report to the Vanderbilt Testing Center.   

If you have not yet obtained your booster shot and are eligible, we strongly encourage you to do so as soon as possible and to register it online. Full vaccination plus the booster is the best protection against COVID-19, and the reported information significantly informs our plans. Those who register their boosters will be exempt from quarantine in accordance with new CDC guidelines and subject to fewer testing requirements. 

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