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COVID-19 At-home Test Kits Available as a Pharmacy Benefit

Last updated on 1/4/2022

The Texas Health and Human Services Commission (HHSC) will include COVID-19 at-home test kits as a Medicaid, Children’s Health Insurance Program (CHIP), Healthy Texas Women (HTW), Kidney Health Care (KHC), and Children with Special Health Care Needs (CSHCN) pharmacy benefit beginning January 3, 2022, for fee-for-service (FFS) and no later than January 17, 2022, for managed care. Clients may obtain COVID-19 at-home test kits from a Medicaid-enrolled retail pharmacy with or without a prescription from a prescribing provider. An adjudicated pharmacy claim is required for reimbursement for a COVID-19 at-home test.

The list of covered tests is below and will be available soon as part of the Formulary Product search on the Vendor Drug Program (VDP) website. HHSC selected these products based on their status under an emergency use authorization (EUA) from the U.S. Food & Drug Administration.

Clients may obtain a maximum number of 4 tests per calendar month. Prescriptions can be processed using single packs (1 test) or multi-pack test kits (2 tests), equaling a total of 4 at-home COVID-19 tests per month. For example:

  • 1 single pack kit (1 test) – allows 4 kits per calendar month
  • 1 multi-pack kit (2 tests) – allows 2 kits per calendar month

Test kits can be dispensed up to the maximum allowed of 4 tests per calendar month with or without a prescription. This new pharmacy benefit will not count against a FFS client’s 3-prescription-per-calendar-month limit.

COVID-19 Test-Kit Name

National Drug Code

Package Size

InteliSwab COVID-19 Rapid Test

08337-0001-58

2 tests

QuickVue At-Home OTC COVID-19 Test

14613-0339-37

1 test

QuickVue At-Home OTC COVID-19 Test

14613-0339-72

2 tests

BianaxNOW COVID-19 AG Card

11877-0011-29

1 test

BianaxNOW COVID-19 AG Card Home Test

11877-0011-33

1 test

BianaxNOW COVID-19 AG Self Test

11877-0011-40

2 tests

Everlywell COVID-19 Test Home Collection Kit DTC

51044-0008-42

1 test

Email VDP-Formulary@hhsc.state.tx.us with questions or comments. spray