Dear Colleagues,
Effective immediately, OptumRx members are eligible for coverage of over-the-counter (OTC) at-home COVID-19 diagnostic tests purchased on or after January 15, 2022. Coverage includes OTC at-home COVID-19 test kits authorized by the Food and Drug Administration (FDA). The most common tests are BinaxNOW™, Flowflex™, InteliSwab™, On/Go™ and QuickVue®. Coverage is limited to 8 individual tests per covered member, every month (i.e., a family of 4 covered members would be eligible for 32 tests a month).
There are three options available to OptumRx members to take advantage of this new benefit:
- Pay $0 at a preferred network pharmacy: Purchase FDA-authorized COVID-19 test kits at a Rite Aid Pharmacy, Sam's Club Pharmacy or Walmart Pharmacy. Simply go to the pharmacy counter, present your member ID card, and ask to have your OTC at-home COVID-19 test kits submitted to your plan for coverage.
- Purchase a kit and then submit an electronic reimbursement form: Purchase an OTC at-home COVID-19 test kit at other stores or online retailers. Keep your purchase receipt(s) to submit for reimbursement. Your plan will reimburse you up to $12 per test by submitting an electronic reimbursement form.
- Purchase a kit and then print and mail in a paper reimbursement form: If you prefer to submit your claim by mail, you can print a paper reimbursement form and then mail it in.
For the most up-to-date information and answers to frequently asked questions, please visit the OptumRx website or the State of New Jersey website.
Sincerely,
Vivian Fernández
Senior Vice President for Human Resources