On January 30, 2023, the federal government announced that the two national emergencies addressing COVID-19, the public health emergency (PHE) and the national emergency, will end on May 11, 2023.
Starting May 12, 2023, health plans and group plan sponsors will no longer be subject to federal requirements for coverage of COVID-19 testing, vaccinations, and treatments.
Below is a summary of the changes to COVID-19 coverage that will take place once the federal emergencies end for fully insured plan sponsors:
COVID-19 vaccines, including boosters
Members pay $0 for the vaccine at in-network locations.*
COVID-19 at-home test kits, also known as over-the-counter or OTC test kits
Members will pay the retail cost of test kits. They are no longer covered
Members can get an at-home test kit for around $12 per test, or $24 for a box of two from CVS® and other retailers. Members can also use funds from a health savings account or a flexible spending account toward test kits.
COVID-19 lab tests and associated provider visits
Members will pay their co-pay, co-insurance, or deductible at in-network locations. It will be applied to their outpatient testing benefit, which is part of their medical plan. Associated provider visits will also follow normal plan co-pay or coinsurance requirements.
COVID-19 antiviral medications or treatments, like Paxlovid*
No change. Members pay $0 for these prescriptions while the government supply is available.
Pharmacist Assessment and Prescribing of Paxlovid Program
Members pay $0 for pharmacist assessment and prescribing of Paxlovid at pharmacies, including CVS®.
COVID-19 monoclonal antibody treatment
No change. Members will continue to pay normal cost-sharing for EUA-approved monoclonal antibody treatments.*
COBRA, HIPAA, special enrollment, and benefit claims and appeals
Deadlines return to normal timeframes starting July 10, 2023.
*Under an EUA declaration, the FDA may authorize unapproved medical products or unapproved uses of approved medical products to be used in an emergency to diagnose, treat, or prevent serious or life-threatening diseases or conditions.
