Want free at-home COVID-19 tests from pharmacies and insurers? It’s not always easy, despite the demands – Chicago Tribune

Some Illinois residents say they are still struggling to get free at-home COVID-19 tests from pharmacies and insurance companies, more than three months after the White House began requiring insurers cover them.

President Joe Biden’s administration announced in January, amid an intense COVID-19 surge, that health insurance companies would be required to cover up to eight at-home COVID-19 tests per month per person. . People were supposed to be able to walk into many pharmacies, flash their health insurance cards and walk away with free boxes of COVID-19 home tests. Or, if a pharmacy was not in-network with their insurance, a person was supposed to be able to submit a claim for at least $12 per test.

But it’s still not that easy — a problem that comes as the number of cases in Illinois rises again, prompting many to seek home testing again.

Some pharmacies require customers to pay for the tests up front and then submit claims to their insurers, even though the pharmacies are among those who are supposed to accept insurance for the tests. Other pharmacies allow insured customers to get the tests at no cost, but ask them to wait up to two hours for them. Some pharmacies say they are out of stock, while others have shelves overflowing with tests.

Those who buy the tests from pharmacies outside of their insurance company’s networks sometimes find that they have to fill out confusing forms to submit claims.

“It’s extremely difficult and I don’t think it’s necessary,” said Teena McClelland, 46, of Portage Park.

McClelland likes to have COVID-19 tests on hand so she can test her family before getting together with others. She also wants to make sure she has them at home in case there is another outbreak of COVID-19, and testing becomes scarce again.

In early April, she tried to buy home tests from a CVS Health pharmacy, but was told they were out of stock.

“I was a bit taken aback by that because I just assumed the pharmacies had that on hand at this point in the game,” McClelland said.

A few weeks later, she then ordered them online from a CVS via Instacart, paying for them in advance. She must now submit a claim for reimbursement. She also decided to try to get some directly through her insurance company, Blue Cross and Blue Shield of Illinois. She called Blue Cross and spent an hour on the phone being transferred to different representatives before any of them could order the tests for her, she said. A bag of tests arrived less than a week later.

Blue Cross spokesman John Simley said in an email that his experience “is not typical” and members can order free tests online or call Express Scripts Pharmacy, a pharmacy in mail order under contract with Blue Cross, at 833-715-0942.

“Every time I’ve tried to do something like this lately, I can’t help but think of people who have more challenges,” McClelland said. “I feel like I have limited challenges. For me to feel challenged by this process, I know it has to be so much worse for others to the point that no one is chasing it.

McClelland isn’t the only one jumping through hoops to get the free tests, which can otherwise cost upwards of $20 for a set of two. This price can be problematic for many people, given that some experts advise people who are not feeling well to take tests as often as daily, in some cases, to see if they have COVID-19.

A Tribune reporter recently visited more than half a dozen pharmacies to try to get free, insurance-covered COVID-19 home tests. The Tribune only visited pharmacies listed as part of Prime Therapeutic’s network with Blue Cross and Blue Shield of Illinois, the state’s largest health insurer, meaning these pharmacies were supposed to allow Blue’s customers Cross / Prime to get the tests for free. Prime is a pharmacy benefit management company owned by the Blue Cross Companies.

Pharmacy workers at two Mariano stores told the Tribune that they don’t do the home tests through insurance, and that customers have to pay for them up front and submit claims for reimbursement.

Three Walgreens pharmacies said they could perform the tests through insurance, but it would take between 15 minutes and two hours. A pharmacy worker at a Jewel-Osco pharmacy said he could get the tests through insurance in 20 minutes, but the store was down to just one box and wouldn’t be in stock for a while. one week.

A pharmacy worker at a CVS store said the tests could be done by insurance in 20 to 30 minutes, but the tests were in a different part of the store. They were near the cash registers at the front of the store, which meant that someone had to find them at the front of the store and then take them to the pharmacy at the back to get them covered by insurance. People can also buy them from the crates at the front, but have to pay for them out of pocket.

When asked why the two Mariano’s stores would not take out insurance for testing, despite being listed as part of the network with Blue Cross/Prime, a Mariano’s spokeswoman said in a statement: “Mariano’s continues to work to align all insurance plans with our system allowing us to request reimbursement directly.”

Marci Conlin, vice president of pharmacy network management for Prime Therapeutics, said in a statement that: “Any pharmacy in Prime’s network is able to submit an electronic claim for COVID-19 test kits on sale. free (OTC). …Prime continues to educate pharmacies on the claims submission process.

Simley, with Blue Cross and Blue Shield of Illinois, said many of the issues Blue Cross is having involve “pharmaceutical procedures or correcting member information.”

“We continue to educate participating pharmacies to ensure they follow the process outlined by the federal government,” Simley said. “If you use a Prime Network pharmacy, you shouldn’t have to submit a separate reimbursement request when you purchase the tests over the counter from the pharmacy.”

Regarding long wait times at some Walgreens pharmacies, Walgreens spokeswoman Kris Lathan said in an email, “Wait times vary based on peak times of day for this location ( like the time before the store closes, for example).”

Jewel-Osco spokeswoman Mary Frances Trucco said in an email, “All of our Osco Drug pharmacies are fully stocked with COVID-19 home tests,” when asked if Jewel stores had few tests.

A CVS Health spokesperson said in an email that customers with certain types of insurance can visit CVS.com or use the CVS Pharmacy app to locate, order and pick up COVID-19 tests at home. no upfront cost, or tests can be covered at drugstore counters. He said CVS stores the tests in various places in its stores, including at the pharmacy counter.

Some Illinois consumers are bypassing drugstore counters altogether to try to get free tests, with varying degrees of success.

The federal government is allowing people to get up to eight free tests per household through https://www.covid.gov/tests. People can get free tests on this site regardless of their insurance status.

Some people who want more than these eight federal government tests order them through store websites or through their insurers online.

Lisa Kelly, 39, of Jefferson Park, bought tests on the websites of Walgreens and Walmart, paying in advance and then submitting reimbursement requests. She had to fill out forms from OptumRx, the prescription drug provider for her insurance plan with Aetna. “It’s really a bit confusing,” she said.

She also ordered the tests directly through an Optum website, with no upfront cost, but she has yet to figure out how to order eight a month for each of her family members, rather than for herself and her husband.

“Maybe if I had gone through the paperwork refund procedure it would have worked out, but that’s a lot of money up front,” she said.

Blue Cross and UnitedHealthcare members can also order up to eight tests per month for free for each person in their household, through insurance-related websites. But a person with Blue Cross must have an Express Scripts Pharmacy online account to order the free tests through Express Scripts. A person with UnitedHealthcare with OptumRx benefits can order them through the Optum Store online website.

However, ordering tests through insurers’ websites can sometimes mean waiting days to weeks for the tests to arrive, which is not ideal for someone who is sick or has just been exposed to the disease. .

“I’m grateful to have access to testing, and I’m grateful that it’s covered, but it’s cumbersome, and it really disproportionately affects people who don’t have time to delve into it or who may not have internet access at home,” Kelly said of the process.

“Families really feel like they’re on their own and they need to get the tests done in case they need them because you can’t always get them done in no time,” she said.

Christy J. Olson