In Biden’s Plan for Free Rapid Tests, Legwork Will Be Required

Over-the-counter rapid coronavirus tests will soon become a much bigger part of the Biden administration’s response to the pandemic and the new Omicron variant.

After a primary focus on vaccination, the White House announced on Thursday that private health insurers would soon have to reimburse patients for such tests. It also said it would make 50 million free tests available for uninsured Americans, to be distributed through health clinics and other sites in rural and underserved communities.

But for consumers who do have insurance, the White House approach will require some legwork. It left some health policy experts questioning why the United States does not purchase tests on behalf of all Americans and provide them at little to no cost, as some European countries have done. Instead, Americans will have to purchase tests and then submit the receipts for reimbursement.

“The direct provision of inexpensive tests for the American public would be the simplest from a consumer standpoint,” said Lindsey Dawson, an associate director at the Kaiser Family Foundation, who has studied rapid testing access. “Someone will need to know it’s reimbursable, navigate the reimbursement process, and front the cost to begin with.”

Other countries have spent more heavily on rapid testing. In Britain, citizens can use a government website to order free rapid tests for home use. Germany invested hundreds of millions of dollars to create a network of 15,000 free rapid testing sites. The United States has instead focused public purchasing on vaccines, and efforts to encourage their uptake.

The recent surge in hospitalizations and the arrival of the Omicron variant prompted the Biden administration to try to expand testing availability and improve affordability. The particular approach probably rests on expedience, said Andy Slavitt, a former adviser to the White House on coronavirus policy.

“From the standpoint of test makers, this takes away the risk of manufacturing, which should help bring costs down,” he said. “They can quantify the market now.”

Private insurers have, in both the Trump and Biden administrations, been an integral part of covering virus testing costs. At the start of the pandemic in 2020, Congress passed a law requiring insurers to fully cover coronavirus tests at doctor’s offices, public sites and other facilities — with no co-payments or deductibles.

Continuing to work through that system, Mr. Slavitt said, may have been the Biden administration’s fastest path to increasing rapid testing access for Americans with insurance, while focusing its direct purchasing work on the uninsured.

“They probably placed a premium on speed, and what they can do to get tests to more people quickly,” he said.

If consumers with private coverage are able to navigate the reimbursement process, and use their health plans to pay for Covid tests, that could lead to an unintended consequence: higher prices.

“If the consumer is thinking, ‘I will get reimbursed,’ they won’t really care about the price,” Ge Bai, a professor of health policy at the Johns Hopkins Bloomberg School of Public Health, said. “The rule is meant to help promote testing, but it also instills inefficiency into the system.”

Dr. Bai worried that the higher prices for at-home tests would be especially problematic for Americans with public coverage, like Medicare and Medicaid, whose plans will not fall under the new rules. The Biden administration hopes to provide testing for those groups by growing the number of free sites across the country.

Right now, test manufacturers set prices for over-the-counter antigen rapid tests. The tests are typically sold in packs of two, with prices ranging from $14 to $34. Drugstores and online retailers have sometimes struggled to keep the tests in stock, particularly when cases are surging.

Some have faulted a slow government approval process — which has limited competition — for the lack of easy-to-find, cheap coronavirus tests.

Reimbursement for Covid tests will not be retroactive, meaning consumers cannot submit receipts for what they have already purchased. The Biden administration said it planned to release new rules outlining the reimbursement process by Jan. 15. It is unclear if the government will limit reimbursements per person.

Some employer-sponsored health plans have been covering the costs of home tests for the last year or so, said Elizabeth Mitchell, the chief executive of the Purchaser Business Group on Health, which represents large companies that provide health benefits to their employees. “Our members have been doing this to keep their work force safe,” she said.

America’s Health Insurance Plans, which lobbies on behalf of private insurers, said it looked forward to learning more about the new policy but was also concerned about the possibility of price gouging with over-the-counter tests, as has been reported with some other testing.

The original policy that required insurers to cover Covid tests at doctor’s offices and test sites did not put a cap on what providers could charge, a policy that has enabled some providers to bill more than $3,000 for a single test.

The White House has not said whether the coming rules will put a limit on the price that insurers will have to cover.