MedImpact issued a bulletin outlining the following COVID-related coverage and policy changes, effective Oct.1 2024, pursuant to the expiration of the American Rescue Plan (ARP):
- COVID-19 OTC tests will be limited to four per member per rolling 90 days. Patients requiring more tests will be required to submit a prior authorization request for review. Kentucky’s Statewide Physician Protocol for Point of Care COVID-19 Testing will be updated to reflect the changes to allowed quantity limits.
- The COVID-19 vaccine administration fee will remain the same. Pharmacies administering COVID-19 vaccines will continue to be reimbursed at $40.
- Pharmacies may continue to bill CPT code 99401 for standalone vaccine counseling.
- COVID-19 treatments classified as EUA (Emergency Use Authorization) may be subject to additional prior authorization review for coverage.
Also in Kentucky, Medicaid issued a Statewide Physician Protocol for Point of Care COVID-19 Testing. The protocol, meant for pharmacies who do not have a medical director, applies only to testing for Medicaid patients.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.