Celebrating the Power of Partnership

During a public health emergency, it helps to have a trusted partner at your side. When Hospitality Rx was faced with a tight deadline involving free, at-home COVID-19 tests, they needed a solution that put members in the driver’s seat.

When new federal guidelines were released on January 10 allowing insurance companies to provide members up to 8 free, at-home Covid-19 tests per 30-day period, private insurers were required to cover costs for tests purchased over-the-counter starting January 15.

Andrea Straszewski, Chief Pharmacy Officer at UNITE HERE HEALTH, a Taft-Hartley Trust Fund, knew that cost and convenience were of concern to members. A lengthy reimbursement process – the easiest approach for the plan – would not be a good solution. “I was committed to a process that paid for tests under the pharmacy benefit,” Andrea explains. Hospitality Rx is an integrated PBM within UNITE HERE HEALTH, a WellDyne client that leverages pharmacy services for their plan members, including specialty.

“Based on the guidelines, we had 5 days – from January 10 to 15 – to set up a smooth, accurate process for Hospitality Rx members to obtain free tests from a number of possible locations,” says David Skomo, WellDyne Chief Operating Officer. “This was a more complex solution than simple reimbursement, but we accomplished it in the five-day window and were able to quickly provide members with instructions for accessing tests.”

The secret to success was simple. “The strong relationship between Hospitality Rx and WellDyne allowed us to work very quickly and nimbly to put the benefit in place,” says Andrea. “Since we handle our own code in the RxClaim system, we have transparency and control to make changes very quickly. Collaborating with Dave, we determined the best ways to code, control, process, track and run detailed reports on the entire process.”

As a result, on January 15 members were able to access free tests through mail order, at either of the 2 Heathcenter pharmacies and at retail pharmacies, both in and out-of-network.

“We recognize and appreciate the power of partnership,” Andrea says. “This is an example of great collaboration between colleagues who have worked in the industry for quite some time. When a never-before-seen government mandate emerged, we found a solution.”

Not every major insurer can say the same. As a Kaiser (KFF) study explains, of 13 major insurers with at least 1M lives, only 6 had some of the COVID-19 test mandate coded and coordinated prior to the January 15 deadline.

“People who do find rapid tests may also have difficulty navigating the reimbursement or direct coverage process,” KFF noted. Pointing out that some of these processes are more consumer friendly than others, KFF recognized that many families could face financial hardship if their insurers require up-front payment for the tests. “Many people do not have easy access to printers or fax machines, required by some insurers for reimbursement, which will likely mean that some claims will never be submitted,” KFF concluded.

“Navigating the Covid-19 pandemic has been full of challenges for families and individuals,” Dave explains. “In this case, we efficiently implemented the back-end components so that on day 1, Hospitality Rx members could get their free, at-home tests, providers would receive reasonable reimbursement and Andrea’s team at Hospitality Rx could rest assured that everything was in place for a positive member experience.”