COVID-19 Information for Providers

Medi-Cal covers the cost of at-home COVID-19 tests for members. Federal Drug Administration (FDA)-authorized, self-administered COVID-19 antigen test kits can be billed and reimbursed as a pharmacy-billed medical supply benefit. Tests must be acquired from pharmacies that are enrolled as Medi-Cal providers. At-home COVID-19 tests are covered by Medi-Cal Rx, not the Alliance.

No-cost test kits from Medi-Cal enrolled pharmacies

Alliance members will need to go to a pharmacy that is enrolled as a Medi-Cal provider. A pharmacist can write them a prescription to get a test kit at no cost. Beneficiaries are limited to eight covered tests per month. However, more tests may be covered if they are ordered or administered by a provider after an individualized clinical assessment.

Out-of-pocket expense reimbursements for test kits

More information on out-of-pocket expense reimbursements is available on the sitio web del Departamento de Servicios de Cuidado de Salud (DHCS, por sus siglas en inglés).

For more information on Medi-Cal Rx coverage of over-the-counter test kits, please view the full guidance on the DHCS website.

• Condado de Merced
• Condado de Monterey
• Condado de Santa Cruz

Several therapies have received Emergency Use Authorization (EUA) from the Food and Drug Administration (FDA). For the latest guidance, please visit the National Institutes of Health’s (NIH) COVID-19 Treatment Guidelines page. NIH has also provided details for therapeutic management of nonhospitalized adults with COVID-19.

The distribution system is managed by the U.S. Department of Health and Human Services. The state and local counties determine where therapeutics will be distributed and which providers will distribute them.

Providers must sign up for the distribution program. Facilities that are able to operationalize COVID-19 therapeutics and would like to be considered for product allocations should contact their Medical Health Operational Area Coordinator (MHOAC).

Locate and order government-supplied treatments 

Please use the resources below to locate sites that have government-supplied COVID-19 therapeutics and to learn how to order therapeutics. Note: therapies are available to specific locations only. 

• COVID-19 Therapeutics Locator: Type in your location and the map will populate nearby sites and the quantity/type of treatment they have in stock.
• Distribution and Ordering of Anti-SARS-CoV-2 Therapeutics

Nota: Reimbursement requests for remdesivir may be submitted to the Alliance. 

Member education 

Please consider educating your patients about the importance of early testing and treatment for COVID-19. Here are a few key points to emphasize: 

• If patients are experiencing any symptoms of COVID-19, they should not wait to seek care. It is important for those with symptoms to talk to their doctor and test for COVID-19 as soon as possible. 
• In order to be effective, therapeutic treatments must be started as soon as possible after testing positive for COVID-19.

For more information on COVID-19 treatments, including product fact sheets and patient-facing communication, visit the California Department of Public Health’s COVID-19 Treatments page.

Test to Treat locations

The federal government is offering a Test to Treat program, whereby participating locations will offer COVID-19 testing and subsequent treatment prescriptions at the same site. Use the U.S. Department of Health & Human Services (HHS) Localizador de sitios para hacerse la prueba de COVID-19 y recibir tratamiento to find participating Test to Treat program sites by address or zip code.

The Alliance covers both laboratory testing and screening for COVID-19.

To ensure you receive appropriate reimbursement, you must submit COVID-19 related claims using the following procedure codes:

For a list of contracted labs, providers may reference the Directorio de Proveedores de la Alianza or contact your Provider Relations Representative.