Update: Per-Claim Fee for OTC COVID-19 Testing Program

February 4, 2022

Applies to ASO groups 

As you’re aware, we’re supporting the federal government’s over-the-counter (OTC) COVID-19 test coverage requirement for employers that have Prime Therapeutics^® coverage through Blue Cross and Blue Shield of Texas (BCBSTX). 

What this means to you: We will bill our self-insured customers who have carved-in pharmacy benefits through Prime an administrative fee of $2.50 per OTC test claim. 

The fee:

• Is retroactive to Jan. 15, 2022
• Applies to paid electronic and paper claims
• Is in addition to the prescription drug cost (OTC test cost) plus dispensing fee that customers would typically see administered as part of a claim
• Will be applied monthly when there is claim volume 

Why are we billing customers a per-claim fee? The federal government’s OTC testing mandate was not accounted for in our forecast modeling. This is the expected cost to administer the program. BCBSTX has and will continue to put a significant amount of unanticipated work into operationalizing this mandate. 

How will this fee be billed? The fee will be reflected on a separate line on the billing statement called “COVID OTC CHARGE.” Please note that the line-item fee name is subject to change. The invoice for the claims will appear on the second month following the paid claims. As an example, ASO groups would see February’s paid claims on their April billing statement.

If you have questions, please contact your account representative.

This information applies to members and groups with prescription drug benefits administered through Blue Cross and Blue Shield of Texas (BCBSTX).

BCBSTX contracts with Prime Therapeutics to provide pharmacy benefit management and related other services. In addition, contracting pharmacies are contracted through Prime Therapeutics. The relationship between BCBSTX and contracting pharmacies is that of independent contractors. BCBSTX, as well as several independent Blue Cross and Blue Shield Plans, has an ownership interest in Prime Therapeutics.