Beginning January 15, 2022, health insurers face new federal requirements to cover and waive cost-sharing for over-the-counter diagnostic tests for COVID-19 for the duration of the federal public health emergency. Past federal guidance required insurers to fully cover COVID-19 tests, but allowed them to require enrollees to first obtain a health professional’s determination that a test is medically necessary. The new requirements, published January 10^th, enable consumers to obtain the tests directly from pharmacies or online retailers without being seen by a health professional.

State insurance regulators will be on the front lines of enforcing the new testing coverage mandate for fully insured individual and group insurance plans. In her latest Expert Perspective for the Robert Wood Johnson Foundation’s State Health & Value Strategies project, Sabrina Corlette breaks down the new rules, potential consumer access and health equity challenges, and implications for state insurance departments. You can read her full post here.