COVID-19 At-home Test Kits Available as a Pharmacy Benefit

Date: January 4, 2022 Attention: All Providers Effective date: January 3, 2022Providers should monitor the Texas Children’s Health Plan (TCHP) Provider Portal regularly for alerts and updates associated to the COVID-19 event.  TCHP reserves the right to update and/or change this information without prior notice due to the evolving nature of the COVID-19 event.Call to action: HHSC will allow COVID-19 at-home test kits as a Medicaid and Children’s Health Insurance Program (CHIP) pharmacy benefit beginning January 3, 2022. Members may obtain COVID-19 at-home test kits from a Medicaid-enrolled retail pharmacy with or without a prescription from a prescribing provider. Texas Childrens Health Plan will allow for a maximum quantity of 4 tests per calendar month. Prescriptions can be processed using single packs (1 test) or multi-pack test kits (2 tests), equaling a total of 4 at-home COVID-19 tests per month. As an example:

• 1 single-pack kit (1 test) – allows 4 kits per calendar month
• 1 multi-pack kit (2 tests) – allows 2 kits per calendar month

How this impacts providers: When prescribing a COVID-19 test kit, the prescribed quantity and any applicable refills may not exceed the benefit limit of 4 tests per calendar month. List of Allowable Test Kits

COVID-19 Test-Kit Name	NDC	Package Size
InteliSwab COVID-19 Rapid Test	08337-0001-58	2 tests
QuickVue At-Home OTC COVID-19 Test	14613-0339-37	1 test
QuickVue At-Home OTC COVID-19 Test	14613-0339-72	2 tests
BinaxNOW COVID-19 AG Card	11877-0011-29	1 test
BinaxNOW COVID-19 AG Card Home Test	11877-0011-33	1 test
BinaxNOW COVID-19 AG Self Test	11877-0011-40	2 tests
Everlywell COVID-19 Test Home Collection Kit DTC	51044-0008-42	1 test

  Next steps for providers: Prescribers should communicate these changes to their staff. If you have any questions, please email Provider Network Management at: TCHPPharmacy@texaschildrens.org.For access to all provider alerts, log into: www.thecheckup.org or www.texaschildrenshealthplan.org/for-providers