Express Scripts’ Coverage for COVID-19 Testing
Coverage of COVID-19 PCR Tests
There is no limit on the number of PCR tests that are covered if ordered, prescribed or administered by a medical health care provider following an individual clinical assessment.
Coverage of At-Home Tests for Non-Medicare Enrollees
Effective Jan. 15, private health insurers, which includes STRS Ohio’s Health Care Program, are required by the federal government to cover up to eight at-home, over the counter (OTC) COVID-19 tests within a 30-day period for each covered non-Medicare enrollee.
Express Scripts, the administrator of the STRS Ohio Prescription Drug Program, has developed an automated system to process these tests for free at network retail pharmacies at the point of sale. Enrollees obtaining tests over the counter should present their Express Scripts ID card at the network pharmacy and the purchase will be 100% covered.
Non-Medicare enrollees who purchased and paid the entire cost for eligible over-the-counter test kits on Jan. 15 or later from a network pharmacy should seek reimbursement. Enrollees may be reimbursed for the following FDA-approved COVID-19 test kits. The FDA may approve additional COVID-19 test kits in the future.
- BINAXNOW COVID-19 AG Self-Test
- ELLUME COVID-19 Home Test
- FLOWFLEX COVID-19 AG Home Test
- IHEALTH COVID-19 AG Home Test
- INTELISWAB COVID-19 Rapid Test
- QUICKVUE At-Home COVID-19 Test
To obtain reimbursement:
Print a claim form and complete it. Attach the pharmacy receipt for the purchase and mail to the address shown on the form. If you need assistance completing the claim form, call Express Scripts toll-free at 866‑685‑2792.
- Confirm you have completed the Covid Test Kit section of the claim form before submitting for reimbursement. Your purchase receipt may include an NDC number and should be included on the form where indicated. If the NDC number is unavailable, you should include the UPC number from the test kit box. See samples of the claim form section and UPC number below.
Sample claim form section
Sample UPC number
You may experience a delay in receiving your reimbursement as Express Scripts anticipates a significant backlog of paper claims during this start-up period.
You can also submit claims for tests obtained from other retailers outside of the Express Scripts network. You will be reimbursed up to $12 per test (or the cost of the test, if less than $12). There is a maximum of eight tests per 30-day period, per individual.
Additionally, enrollees can order free over-the-counter Covid-19 test kits through the Express Scripts Home Delivery Pharmacy. The only caution is that once an order is placed, it counts toward your 30-day limit of eight test kits even though you would not have received them yet in the mail. Delays in receiving your tests are possible and could become lengthy if supplies at the home delivery facility are exhausted.
This information is subject to change as the federal government continues to regularly issue new pandemic-related guidance and refine existing requirements. Please stay informed by reading all information provided by the federal government, Express Scripts, your medical plan and STRS Ohio.
This article is not intended as a substitute for applicable federal or state law, nor will its interpretation prevail should a conflict arise between its contents and applicable federal or state law.