Beginning January 15, 2022, eligible members can go to a retail pharmacy and obtain up to eight tests at the pharmacy counter without member cost sharing when the tests are used to diagnose a COVID-19 infection. In addition, many pharmacies, including retail, can ship over-the-counter, at-home COVID-19 test kits to eligible members. Every eligible member, including covered dependents, may obtain up to eight tests every 30 days.

Regardless of how members get the tests — retail or online — they will be eligible to purchase up to eight tests per member every 30 days. However, due to supply and demand, pharmacies and online retailers may limit the number of tests purchased at one time.

Members who buy the tests at the pharmacy counter or through in-network mail order pharmacies, do not need to submit claims.

Members who choose to pay out of pocket and buy tests to diagnose a COVID-19 infection outside of the arrangements Horizon made will need to submit a pharmacy claim form to Prime Therapeutics LLC for reimbursement. The pharmacy claim form will be available on HorizonBlue.com/forms. Members will be reimbursed for the cost of the test or $12 per test, whichever amount is lower.

Which OTC At-Home COVID-19 Tests Are Covered?
At-home COVID-19 tests that are authorized by the U.S. Food & Drug Administration (FDA) as Over-the-Counter (OTC) are covered. These tests are given at home and the results are read at home, without involving a doctor, other health care professional or lab.