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COVID Testing, Treatment and Vaccines

Roughly three years ago, the world as we knew it abruptly changed. Today’s video reports on changes related to our journey back to normalcy. Throughout the pandemic era, COVID testing, treatment and vaccines were covered with no cost-sharing or member responsibility payments. Although COVID vaccines will continue to be covered indefinitely with no cost sharing, those who have commercial coverage and Medicare will soon need to pay their share of costs for COVID testing and treatment. This is due to provisions in The Families First Coronavirus Response Act of 2020 expiring and the COVID public health emergency officially ending May 11.

The cost of testing shouldn’t be too burdensome for most people because rapid tests are in wide use and reasonably affordable. If a Polymerase Chain Reaction (PCR) test is sought, that will be more expensive if you haven’t met your deductible. Worst case you could end up like me as I state in the video, making an appointment in-network thinking it would be covered and eventually needing to seek out an out-of-network pharmacy that charged $280 for my test (rather high I believe).

The great irony of my situation was that I needed the test results to accompany a relative to surgery but when I got to the hospital, they didn’t even ask for results even though it was supposedly a requirement to enter the hospital. Perhaps I shouldn’t extrapolate my experience but it seems PCR testing will not be as important in an environment where most people are vaccinated. And from everything I’ve read, PCR tests are so much more sensitive that they can often detect the presence of COVID long after one is infectious – which is not helpful.

As always, be mindful of staying in-network. I made an in-network appointment for my PCR test (of course!) only to find that the pharmacy expected me to send the specimen directly to the lab and it wasn’t clear the timing would work in terms of the hospital’s stated requirements.

As for treatment, the cost of Paxlovid could certainly get your attention if you are in your deductible period but in an era where COVID is not the crisis it once was, it is difficult to justify not treating Paxlovid like other prescription medications.

It does seem like we got it right from a public health perspective in making COVID vaccines permanently available with no cost-sharing. With such an overriding societal interest in maintaining a highly vaccinated population, not imposing a financial barrier to an already unpleasant experience, seems wise. Of course, although the intent is to make COVID vaccines available permanently without cost-sharing, that might one day change. Also, it is confusing to read that Moderna is setting the price for its vaccines at roughly $130 per dose but that is the list price which the uninsured might pay without some type of assistance or discount but not those with coverage. Most important, let’s never forget how fortunate we are that vaccines were available so quickly.

The video addresses the issues of the general public, not healthcare or other specialized workers who may be subject to additional testing presumably at the employer’s expense. And there are those of us for whom testing and treatment may remain a stressor – regular visitors at hospitals and nursing homes, for example.

In all, these changes reflect how far we’ve come in returning to living normal lives, freely able to socialize and travel. It continues to make sense to keep some rapid tests on hand, of course, so we can do our best to minimize spread if we contract COVID. You might just check your insurance portal later in May to see what information on COVID testing, treatment and vaccines is provided but this piece describes what is supposed to happen. Most important, keep up with boosters, as appropriate, and encourage others to do so.

Thanks for your kind attention and take good care.