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Applies to Group and Retail
As you’re aware, the federal government released guidance this week about coverage of over-the-counter (OTC) COVID-19 diagnostic tests.
Some key highlights:
What this means to you: BCBSNM will cover COVID-19 diagnostic OTC tests through our extensive network of participating pharmacies, for our fully insured members, and self-insured group members who have Prime Therapeutics® coverage through BCBSNM.
Members can use the same broad networks used for COVID-19 vaccines to request tests. Claims will be submitted directly from the pharmacy to BCBSNM.
In-network locations include:
Self-insured customer approach:
For our self-insured customers who use BCBSNM and Prime Therapeutics to administer their pharmacy benefit, here's our approach:
Our self-insured customers who have their pharmacy benefits carved-out will need to confirm how their carved-out PBM is managing COVID-19 diagnostic OTC testing.
While we provide information about federal guidance, we do not provide groups with legal or compliance advice. Group customers must contact their legal advisors if they have questions about proposed rules and new regulations, what they will require and how they will affect their benefit plans if finalized.
This information applies to members and groups with prescription drug benefits administered through Blue Cross and Blue Shield of New Mexico (BCBSNM).
BCBSNM 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 BCBSNM and contracting pharmacies is that of independent contractors. BCBSNM, as well as several independent Blue Cross and Blue Shield Plans, has an ownership interest in Prime Therapeutics.