Coronavirus Preparedness To Include Testing Costs Coverage
HARTFORD — Governor Ned Lamont announced March 10 that in order to prepare for coronavirus disease (COVID-19), his administration is working with health insurance carriers in Connecticut to cover the costs for COVID-19 testing and to ensure, in accordance with the provisions of Section 20-616a of the Connecticut General Statutes, access to maintenance prescription drug medications (excluding controlled substances).
The statute provides pharmacists the discretion to fill a 90-day refill of prescription drugs under certain circumstances, even if the original prescription was for a lesser amount. Assuming the other circumstances are met, including coverage under the customer’s health plan, the health insurance carriers will cover the refill quantity dispensed, without additional coinsurance, deductible, or other out-of-pocket expense required from the patient. Patients will still be expected to provide the usual coinsurance, deductible, or other out-of-pocket expense associated with a 90-day refill. Customers who rely on maintenance drugs to treat a chronic or long-term condition should contact their pharmacist to discuss acquiring these refills. They can also speak with their insurance carrier about beginning to receive refills by mail order. Pharmacists who use their professional judgement to refill a prescription early should make a documentation on the patient’s record and consult with the prescribing practitioner within 48 hours as required.
Governor Lamont and Insurance Commissioner Andrew N. Mais are also encouraging all Connecticut health insurers regulated by the Connecticut Insurance Department to consider waiving cost sharing related to a provider visit and testing for COVID-19, as outlined in a bulletin the department issued last night (IC-39). In addition, insurers are encouraged to consider waiving cost sharing for medical advice and treatment of COVID-19 via telehealth services.
“We are doing everything in our capacity to put adequate plans in place for anyone who is impacted by this situation, and I thank each of Connecticut’s insurance carriers and our state’s pharmacists for working with our administration to make this possible,” Governor Lamont said. “I thank the commissioner and his team at the Insurance Department for their leadership working with our partners in the health insurance industry to ensure that we are prepared to adhere to best practices in order to curtail the spread of the virus.”
“Testing is the first step toward stopping the spread of the virus, and telemedicine allows patients to consult with a medical professional without potentially compromising the health of office staff and the public,” Commissioner Mais said. “Telemedicine can be a vital tool to combat this public health challenge.”
The Connecticut Department of Social Services (DSS) is also working with its federal partners to modify the prescription refill processes in Medicaid/HUSKY Health.
“We anticipate releasing new guidance to allow 90-day refills and align with the changes announced today by Governor Lamont,” DSS Commissioner Deidre S. Gifford said.
Those enrolled in many fully insured, employer-sponsored plans and plans purchased through Access Health CT will be able to take advantage of these benefits. Consumers should be aware that not all health plans are regulated by the Connecticut Insurance Department. Many employer-sponsored plans are self-funded and regulated by the federal government under ERISA.
“I’m encouraging all employers to follow the lead of the health insurance industry in affirming that their plans will be covering coronavirus testing with no out-of-pocket costs,” Connecticut’s Healthcare Advocate Ted Doolittle said.
Response From Connecticut’s Health Insurance Carriers
Karen S. Lynch, executive vice president of CVS Health and president of Aetna Business Unit: “As we navigate the spread of COVID-19, we are deeply committed to ensuring timely and seamless access to care. That’s why we announced last week that we’re providing COVID-19 diagnostic testing and telemedicine visits with no out-of-pocket costs or cost sharing for Aetna members, and announced further enhancements today to prevent interruption of medication availability. We join Governor Lamont in encouraging Connecticut residents to talk to their pharmacists about maintaining adequate supply of medications. Pharmacists at CVS Health are available to counsel patients on their options to refill prescriptions early and extend prescriptions from 30 to 90 days.”
Jill Hummel, president of Anthem Blue Cross and Blue Shield in Connecticut: “Improving lives and communities is an important part of Anthem’s mission. Towards that end, amid the growing concerns about the potential spread of COVID-19 in communities across the state, Anthem has previously announced efforts to eliminate the burden of additional costs for members by providing coverage of the coronavirus screening test at no out-of-pocket-cost. We remain committed to keeping healthcare affordable for the consumers we serve, and working with state leaders to help contain the spread of this virus.”
Wendy Sherry, president of Cigna’s Connecticut market: “As we face this serious challenge to public health, it’s critically important that we all work together to safeguard our communities. That’s why Cigna will cover the full cost of COVID-19 testing for our customers when it’s prescribed by a health practitioner. By removing barriers to COVID-19 testing, we can help contain the spread of virus, while bringing peace of mind to our customers in Connecticut and around the world.”
Eric Galvin, president of ConnectiCare: “As Connecticut’s health insurer, we stand ready to help our customers who are concerned with COVID-19. We have worked with the administration to help remove barriers to accessing care and remind our customers to use telehealth if they have symptoms. Also, take advantage of 90-day prescription refills and home delivery for maintenance medications.”
Michael Carson, president and chief executive officer of Harvard Pilgrim Health Care: “As we face the ongoing challenge of the coronavirus, we want our members to know that we support them at this critical time. We share Governor Lamont’s commitment to ensuring the health and well-being of our neighbors and community.”
Dr Richard Migliori, chief medical officer, UnitedHealth Group: “Our top priority is the health and well-being of the people we serve. By waiving cost sharing for diagnostic tests for COVID-19 for our insured health plan members, helping members who need an early refill of their prescription, opening our Emotional Support Help Line, and promoting the use of virtual visits, we are making it easier for people to get the care and support they need.”
For the most up-to-date information from the state of Connecticut on COVID-19, including guidance and other resources, visit ct.gov/coronavirus.