Earlier this month, Gov. Phil Scott made a big announcement: The state would require pharmacies to offer rapid COVID tests with no upfront cost.
Paul Caron was really excited to hear about this plan, because he's spent a lot of money on tests over the past few months. He uses them whenever he visits relatives in Massachusetts.
“I use the tests before I go, after I go, while I’m gone,” he said. “I just thought that would be great, not to have to pay for the test.”
Rapid tests, also called antigen tests, are not as sensitive as a PCR test — the kind you get from the Department of Health — but they can tell you if you have enough virus in your body to infect someone else, and you get the results back in a couple minutes.
So a few days after Caron heard this plan from the governor, he stopped at a pharmacy in Middlebury, thinking this time, he wouldn’t have to pay for a test. They usually run between $15 to $40 per kit. But when he went to check out, things didn’t go as expected.
“The person said they would check me out and sell it to me, and I kind of said, ‘No, thanks,’ and I threw it back on the shelf,” he said.
Caron went to another pharmacy, where rapid tests were sold out. And they told him they’re not providing these tests for free until January anyway. So he went back to the first place and paid to get his test, just so he would have one for the holidays.
He says the whole experience was disappointing after what he heard from the governor.
“I was just surprised it didn't work out the way he said it would,” he said.
“If you call our customer service and have the receipts and the proper test, then you can get refunded for that. But I don't believe that information right now is broadly known.”Sara Teachout, Blue Cross Blue Shield of Vermont
At most pharmacies in Vermont, you still need to pay to get a rapid test, like Caron did. But some Vermonters can get their insurance companies to reimburse the cost of these tests — either those purchased online or at a store.
That’s because of this new state rule that says insurance companies have to pay for these tests — up to eight kits a month, from as early as Dec. 1.
“If you call our customer service and have the receipts and the proper test, then you can get refunded for that,” said Sara Teachout, of Blue Cross Blue Shield of Vermont. “But I don't believe that information right now is broadly known.”
If you’re one of their customers with a pharmacy benefit, you can get any rapid test authorized by the FDA reimbursed, under the state rule.
But there is a big caveat here. The rule only applies to health insurance companies the state can regulate, like Blue Cross Blue Shield of Vermont.
The Department of Financial Regulation estimates that some 140,000 Vermonters have insurance that falls into this bucket. They’re advising people to check with their insurance company about reimbursement ahead of time.
Either way, the thing Caron wanted was to avoid all this paperwork and having to lay out cash upfront.
The plan the governor talked about was being able to walk into a pharmacy and pick up a rapid test like it’s a prescription, without having to pay. For that to work, you still need to be covered by specific insurance or Vermont Medicaid, and you need to be able to get a hold of one of these tests.
That might be the biggest challenge of making this plan a reality.
“That's what I hear is going to be the entry point issue for Vermonters,” Teachout said. “If you go to the store and there's no test, I think people will be very frustrated.”
Some pharmacies say they already have a bunch of these tests on hand, like Kinney Drugs.
“I don’t want to say this and shoot myself in the foot here, but we’re in a pretty good spot,” said John Marraffa, president of the pharmacy chain, which has about a hundred stores spanning Vermont and New York.
Even so, a number of Kinney stores around Burlington were sold out of rapid tests a few days before Christmas.
"I look forward to the time when we can give them to whoever needs them.”Craig Pike, Ottauquechee Pharmacy in Woodstock
For other pharmacies that don’t already have a stockpile, getting these tests has posed a major challenge.
"Every major wholesaler in the country is having difficulty acquiring these,” said Jeff Hochberg. He’s president of the Vermont Retail Druggists Association, a group of independent pharmacies across the state.
One reason tests are in such short supply is that there’s only a handful of brands that pharmacies can bill insurance companies. And right now, Hochberg said he only has access to two of these tests.
“They are the two highest priced ones on that list,” he said. “They are very difficult to get. They are on extreme allocation, whereby I’m allowed to order one box a day."
Despite all these hurdles, at least one pharmacist in Vermont says some customers have been able to pick up rapid tests without having to pay.
“We've successfully billed probably eight of those tests this week, I'd say. But obviously now we're out of them,” said Craig Pike, who works at Smilin' Steve's Ottauquechee Pharmacy in Woodstock.
Ottauquechee Pharmacy is a small room on the basement floor of a health center. They recently secured a large supply of rapid tests, more than they’ve had in months. But Pike doesn’t know when they’ll come in — it might not be until well after the holidays.
“I wish I even had a ballpark,” he said. “I look forward to the time when we can give them to whoever needs them.”
Lexi Krupp is a corps member for Report for America, a nonprofit national service program that places journalists in local newsrooms to report on under-covered issues and regions.
Have questions, comments or tips? Send us a message or get in touch with reporter Lexi Krupp @KruppLexi.
