RI COVID-19 Test Standing Order: Allows direct billing insurance at pharmacies

Under a new standing order, every person in RI with either Medicaid or private health insurance should be able to pick up COVID-19 rapid antigen test (RAT) kits from any pharmacy without having to pay up-front.

Despite a federal government mandate that health insurers must cover up to eight kits per month for every covered individual, carriers instructed pharmacies to require up-front payment for which customers could seek reimbursement unless they had a prescription. This policy applied even to very low-income insured persons, including those on Medicaid, for whom the cash requirement and paperwork hassle are prohibitive.

As we reported previously (“News Analysis – Failure on COVID-19 rapid testing availability: Insurers game the system”, by Michael Bilow, Feb 6, 2022), to solve this problem the federal Centers for Medicare and Medicaid Services (CMS) “recommended that states issue a standing order for pharmacies for tests, including over-the-counter tests, as opposed to requiring a prescription per person to alleviate beneficiary and provider burden.”

The RI Department of Health (RIDOH) in response to repeated inquiries from Motif said that such a standing order was under consideration, but finally advised that it had been issued. (Download it from motifri.com/wp-content/uploads/2022/03/RI-COVID-home-test-standing-order-f.pdf.) The order states: “Suzanne Bornschein, MD, being an actively licensed Rhode Island physician, shall serve as the prescribing physician for this standing order… The general public may visit a participating pharmacy on a walk-in basis to receive any type of OTC COVID-19 test kit, up to 8 tests per individual per month.” The protocol per the order is: “Individuals shall provide their insurance information and required patient demographics to the pharmacist/pharmacy staff and request that the test be billed to their health insurance company. The pharmacist/pharmacy shall enter Dr. Suzanne Bornschein M.D. as the prescribing provider when submitting the claim to the third-party insurance carrier.”

Families on the same insurance plan are eligible for RAT kits on an individual basis, so a family of four would be eligible for eight each, or 32 tests, per month.

Motif has received reports that many pharmacies are out of stock on RAT kits, but has been unable to determine the scope of the problem.

Medicare (as opposed to Medicaid) patients are not covered for RAT kits but are eligible for PCR tests.

In addition, every residential address in the US can order four more RAT kits for free, even if they have previously ordered an initial four tests, through an official government web page: covidtests.gov (which currently redirects to a site operated by the US Postal Service special.usps.com/testkits). Persons need enter only their name and shipping address to place a free order, and optionally can enter an e-mail address to be notified about order progress.