Healthy on the Hill - Messages

Dear Employees Enrolled in WKU’s Health Insurance Plans,   

As of January 15, 2022, we will be covering certain over-the-counter (OTC) COVID-19 tests for eligible plan participants. WKU is pleased to inform you that we have elected to participate in a program offered through our pharmacy partners, the Know Your Rx Coalition (KYRx) and Express Scripts Inc (ESI), that will allow you to obtain OTC COVID-19 tests with no out of pocket costs to you, similar to other preventative medications. This email provides a summary of how you can get these tests. We will provide an update to the rules as additional guidance is released. 

Free At-Home COVID Tests by Mail (available for every household in the U.S.)

A recent announcement from the federal government provides for a maximum of four at-home tests per household. The tests are free and orders are estimated to ship within 7-12 days. You may order tests at http://www.COVIDtests.gov.  This is a great option as there is no cost to you and does not generate additional WKU plan costs.

Over-the-Counter COVID Tests (available for all members covered by WKU’s health insurance plans)

As a reminder, WKU is a member of the KYRx Coalition, joining with other state and regional universities to reduce costs. The Coalition makes use of a retail pharmacy program with a broad network of Express Script pharmacies which include major pharmacy chains and independent stores. WKU employees enrolled in our medical plans are automatically covered under this prescription drug plan. Effective January 15th, plan participants may receive over-the-counter diagnostic COVID-19 tests at no cost, until the end of the Coronavirus Public Health Emergency. Each member can get up to eight over-the-counter tests per 30 rolling days. If you purchase a test kit that includes two rapid tests, that will count as two of your eight covered tests. Effective 1/28 you can get the tests from any ESI in-network pharmacy with zero copayment at the point of sale.

Here’s how it works:

·       Call your local retail pharmacy to see if they have at-home COVID-19 tests available.

·       Take your Anthem ID card to a retail pharmacy in your network.

·       Bring the COVID-19 test to the pharmacy counter, not the regular checkout lane.

·       Check out at the pharmacy counter and show your Anthem ID card. Your at-home COVID-19 test should automatically ring up at no cost to you.

Helpful Places to Find Information:

To find a retail pharmacy in your network visit express-scripts.com and click “Find a Pharmacy.” You can also use their mobile app. If you weren’t able to purchase your at-home COVID-19 test(s) at the pharmacy counter of an in-network pharmacy, or were incorrectly charged for the tests, you can submit your receipt for reimbursement at ESI’s COVID-19 resource center or log in to your Express Scripts account for directions to submit manual claims: Manual reimbursement.  Note that this process is relatively new so there may be some administrative challenges early on. If you secure the tests out-of-network, you will be required to pay out-of-pocket and then submit for reimbursement.  Out-of-network reimbursements are capped at $12 per test and you will be responsible for any balance. You can submit for reimbursement from ESI’s COVID-19 resource center or log in to your Express Scripts account for directions to submit manual claims: Manual reimbursement. Be sure to keep your receipt to submit your claim. For more information about COVID-19, or to submit a receipt for reimbursement, visit the Express Scripts resource center at express-scripts.com/covid-19/resource-center.

Keep in mind that although you are able to receive tests with zero co-pay through Express Scripts pharmacies, there is a cost to our self-funded health plan. Therefore, we urge you not to purchase unnecessary tests. Further, you should be aware that the tests have an expiration date and may not be effective after that date, so we encourage you not to stockpile tests. Additionally, keep in mind that this process is new and you may experience a slight wait at your local pharmacy while processing your test orders. 

Additional Treatment Options (available for all members covered by WKUs health insurance plans)

•     In late December 2021, the U.S. Food and Drug Administration (FDA) issued an emergency use authorization for Pfizer’s PaxlovidTM and Merck’s molnupiravir for the treatment of mild to moderate coronavirus disease (COVID-19) for certain patients who are high risk for progression to severe COVID-19, including hospitalization or death. These treatments are available by prescription only, and the FDA recommends initiating them as soon as possible after diagnosis of COVID-19 and within five days of symptom onset. These prescriptions are covered by your pharmacy benefits through Express Scripts. If you receive a prescription from your health care provider, please call your pharmacy to ensure they have availability before you arrive. 

If you have questions about COVID-19 as it related to your coverage by the Know Your RX Coalition/Express Scripts or Anthem, please contact the appropriate carrier:

• Pharmacy - Know Your Rx Coalition Member Services: 1-855-218-5979, www.kyrx.org
• Medical – Anthem Member Services: 1-844-248-1153, www.anthem.com

Best wellness regards, 

WKU Employee Wellness & Benefits