Programs for Free Access to COVID-19 Tests Effective, Need Communication

A new report from Safely Opening Schools (SOS) showed that programs allowing consumers free access to COVID-19 tests were effective—so long as people knew about them.

The program, which sunset on May 11 as part of the rollback of the federal public health emergency (PHE), required public and private payers to cover up to eight free COVID-19 tests each month for insured people.

The measure, implemented in January 2022, was intended to improve consumer access to COVID-19 tests and increase the monitoring of disease spread. Ideally, the measure would make it easier to return to daily living by helping people know when they had contracted the novel coronavirus.

And that program worked, at least among people who knew about it.

“Far too many vulnerable Californians weren’t aware that this program exists or that for many, it will end soon,” Nicole Maderas, MPH, the lead author of the report and SOS outreach and engagement manager, said in a press release. “The good news is that when people knew their rights, they were overwhelmingly successful in walking out of the pharmacy with free COVID tests. Consumers need to act now to use their rights.”

Using a “secret shopper” survey style in California, the researchers were able to ascertain that the program was mostly frictionless. Eight in ten visits to pharmacies resulted in successfully obtaining the at-home tests.

The secret shoppers were consumers themselves, including high school students. The researchers said shoppers made over 475 pharmacy visits and used various types of insurance plans, including private insurance plans and California’s Medicaid plan, Medi-Cal.

Overall, pharmacies played their role in fulfilling requests for covered COVID-19 tests. The process did not get stymied at the retailer. Specifically, secret shoppers saw a 94 percent success rate at Kaiser Permanente pharmacies, 80 percent in other chains, and 66.7 percent success at independent pharmacies.

Success was also nearly universal across payer types, with Medi-Cal being the most likely to cover tests with no upfront costs (84.4 percent of visits). Consumers with private insurance were able to get tests with no upfront costs in an average of 73 percent of visits. However, success varied greatly by payer; for some private plans, success rates were as low as 36.4 percent and, in others, as high as 100 percent.

Although pharmacies and insurance companies did deliver on the free tests when asked, the researchers did point out that patient education about the program was lacking; the vast majority of secret shoppers did not know about their right to free COVID-19 tests before participating in the study.

Public health communication and marketing of the program fell short, the researchers said. Fewer than one in ten (8.6 percent) of pharmacies had signs in English explaining that insured consumers could get free COVID tests. There were even fewer signs in other languages, with only around 4.6 percent of pharmacy visits having a sign.

And there’s still that 20 percent of pharmacy visits that did not result in obtaining a free test. That failure was usually because the pharmacy did not have any tests in stock, but sometimes it was because the pharmacy was going to require an upfront payment with the consumer option to get reimbursed after the fact. In those cases, only 41 percent of pharmacies explained the reimbursement process to consumers.

These findings demonstrate public health’s ability to support patients, but underscores the need to complement policy with communication and education. Mandated coverage of at-home COVID-19 tests lapses after May 11, but the researchers still urged healthcare policymakers and insurers to extend the measure, citing the nearly $100 cost for eight tests.

“COVID is still costing Californians a high price in lives lost, hospital visits, and days too-sick to work,” reflected Samar Hadrous, Associate Testing Strategist with SOS. “This policy provides an enormous opportunity for people to protect their health and the health of those they love. We strongly urge families to stock up on free tests now, while this benefit is still offered.”