WellDyneRx Response to Novel Coronavirus (COVID-19)

Updated 01.21.2022

Friday, January 21, 2022
Latest Guidance About the OTC COVID Test

The Biden administration issued guidance recently requiring private health insurance companies to reimburse and cover members for up to eight (8) over-the-counter (OTC) COVID-19 tests per month.

Client Enrollment Process:

Clients will be automatically enrolled into WellDyneRx’s COVID-19 Test Kit program. If a client wishes to opt out of coverage for COVID-19 test kits, please contact you’re your dedicated Account Manager by January 26, 2022.

Member Details:

  • A written prescription or prior authorization is not required.
  • Each member is eligible for up to eight (8) OTC COVID-19 tests per month.
  • In Network: Point-of-sale (POS) and mail order coverage at participating network pharmacies is currently unavailable. Members must submit a claim form and a copy of their receipt for reimbursement.
  • Out of Network: Members must submit a claim form and a copy of their receipt for reimbursement.
  • Members can obtain test kits at any retailer. However, reimbursement for out of network pharmacies and retailers is capped at $12.
  • Confidio Clients: Contact the WellDyneRx customer service number noted on ID cards for assistance filing claims.

Member Cost:

  • In Network: $0.00 POS and mail order, no shipping costs
  • Out of Network: Plan reimburses 100% (A Safe Harbor status change may apply a $12 reimbursement cap.)
  • Mail Order = $0.00
  • Out Of Network = $0.00, plan reimburses 100% until Safe Harbor allows $12 reimbursement cap

Plan Cost:

  • For OTC kits processed through the pharmacy benefit, WellDynRx will process payment of OTC COVID-19 test kits at market-competitive rates. A Safe Harbor status change may apply a $12 reimbursement cap for out of network.
  • Standard contract terms apply for paper claim processing (Outlined in client contract.)
  • Additional Program Fees: $2.50 fee per manual claim submission
  • Standard billing cycle

Additional Resources

Friday, January 14, 2022

Important Information About the New OTC COVID Test Guidance

Client Enrollment Process:

  • WellDyneRx is utilizing an opt-out solution. Coverage for all clients will be updated to include COVID19 Test Kits. If your client would like to opt-out, please contact your Account Manager.

Claim Adjudication Process:

  • Effective January 15, 2022, COVID19 test kits will not process at point of sale. Members will pay cash and submit a direct member reimbursement (DMR) claim to WellDyneRx.
  • DMR member reimbursement will be capped at $12 per test.
  • WellDyneRx is actively working towards a point-of-sale solution to allow claims to adjudicate at a $0 cost share with a $12 cost cap.
  • Members will be limited to eight (8) tests per month.
  • No prior authorization or attesting to COVID Symptoms required for coverage.

 COVID19 Test Kits will be excluded from all pricing and rebate guarantees.

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