Since the start of the pandemic, Blue Cross and Blue Shield of North Carolina (Blue Cross NC) has fully covered COVID-19 tests ordered by a health care provider that have been FDA-approved or received emergency use authorization (EUA).
Now, we’re making tests more accessible and lowering member costs by covering eight (8) approved over-the-counter (OTC) tests each month, beginning January 15, 2022, and continuing throughout the current public health emergency (PHE).
These tests do not have to be ordered by a doctor and can be self-administered and self-read at home.
Purchasing an OTC Test
Members who present their Blue Cross NC member ID card at an in-network pharmacy counter will pay no out-of-pocket costs when purchasing an eligible test kit.
Members who purchase tests without their Blue Cross NC prescription drug card at an out-of-network pharmacy or other retailer can pay out of pocket and mail an OTC test claim form* to our pharmacy benefit manager, Prime, for reimbursement.
Reimbursement for test kits purchased from out-of-network pharmacies and retailers is limited to no more than $12 per individual test. To be reimbursed, the test must be FDA-approved or have EUA.
- Members are eligible to receive up to eight (8) OTC COVID-19 tests per month for reimbursement. Each test is counted separately regardless of how many tests are sold in one package.
When submitting a claim to be reimbursed, members must mail a:
- Completed OTC COVID-19 test claim form*
- Purchase receipt documenting the date of purchase and the price of the test
- The test’s UPC code
The address to mail the OTC COVID-19 test claim form is:
Mail route: Commercial
PO Box 25136
Lehigh Valley, PA 18002-5136
Upon receipt of the required materials, Prime will issue a reimbursement check, typically within 21 days. Depending on volume, additional time may be needed for processing.
Most Blue Cross NC members should not need reimbursement for their OTC COVID-19 tests. If members present their Blue Cross NC member ID card at an in-network pharmacy counter, they will pay no out-of-pocket costs.
*Note: the claim form should be completed for OTC COVID-19 tests. A pharmacist signature and pharmacist NPI number are NOT required on the claim form. However, the member MUST sign the form attesting that the test kits are not being used for testing required by their employer, return to work, travel, attending recreational events, and will not be resold.
OTC testing coverage applies to members of Blue Cross NC's fully-insured (individual and group), Administrative Services Only (ASO) group health plans and the Federal Employee Plan (FEP).
The requirements do not apply to Medicare plans, excepted benefits (such as stand-alone vision or dental) or retiree-only plans.
If the back of your Blue Cross NC ID card doesn't list Prime as your prescription drug plan, you may have a different pharmacy benefit manager. If this is the case, please ask your employer or benefits manager about your OTC testing reimbursement options.
COVID-19 tests for general workplace health and safety (such as employee "return to work" programs) are not required to be covered.
- North Carolina Department of Health and Human Services (NCDHHS) Testing Information
- Testing Options in North Carolina
- Testing Locations Beyond North Carolina
- Order Your Free At-Home COVID-19 Tests from the Federal Government
- List of North Carolina In-Network Pharmacies for OTC Tests
- At-Home Testing Guidance for the General Public (Spanish)