Date

Effective November 1, 2021, MO HealthNet will cover at-home COVID-19 tests through the Fee-for-Service pharmacy benefit when prescribed and dispensed by MO HealthNet enrolled providers. At-home COVID-19 tests will be covered for participants who are dually eligible for Medicaid and Medicare when the test is excluded from Medicare Part D coverage.

Reimbursement:

MO HealthNet will reimburse pharmacy providers the lesser of the Maximum Allowable Cost (MAC) rate plus a dispensing fee or the Usual & Customary submitted by the provider. The current reimbursement per unit for an at-home COVID-19 test is $12.

MO HealthNet will not reimburse participants directly for at-home COVID-19 tests. MO HealthNet will only reimburse for at-home COVID-19 tests when prescribed and dispensed by MO HealthNet enrolled providers.

The current list of covered at-home COVID-19 tests is:

  • PIXEL COVID-19 HOME COLLECT KT
  • INTELISWAB COVID-19 HOME TEST
  • LUCIRA CHECK-IT COVID HOME TST
  • BINAXNOW COVD AG CARD HOME TST
  • BINAXNOW COVID-19 AG SELF TEST
  • QUICKVUE AT-HOME COVID-19 TEST
  • CARESTART COVID-19 AG HOME TST
  • EVERLYWELL COVID19 HOM COLLECT
  • IHEALTH COVID-19 AG HOME TEST
  • ELLUME COVID-19 HOME TEST
  • FLOWFLEX COVID-19 AG HOME TEST

Additional at-home COVID-19 tests continue to be authorized and may be added to the covered list. MAC pricing for at-home COVID-19 tests can be found at: https://dss.mo.gov/mhd/cs/pharmacy/pages/mac.htm

Pharmacists prescribing at-home COVID-19 tests for MO HealthNet participants:

Per the PREP Act Declaration 3rd Amendment, pharmacists can prescribe at-home COVID-19 tests. At-home COVID-19 tests must be prescribed by an enrolled MO HealthNet provider for MO HealthNet to reimburse for the at-home COVID-19 test. Pharmacists who prescribe at-home COVID-19 tests for MO HealthNet participants, must be an enrolled MO HealthNet provider to receive reimbursement.

Additional information:

At-home COVID-19 tests may also be ordered from the Federal Government at no cost. More information is available at: https://www.covidtests.gov/.