COVID-19 Information for Providers

Federal Drug Administration (FDA)-authorized Over-the-Counter (OTC) COVID-19 antigen test kits are available for free for members at the pharmacy.

Medi-Cal members:

Starting 1/1/26, OTC COVID-19 antigen tests will require a prior authorization (PA) request for all Medi-Cal members.

For more information on Medi-Cal Rx coverage of over-the-counter test kits, please view the Medi-Cal Rx Provider Manual.

Alliance Care IHSS members:

• Members can obtain up to eight at-home test kits per month at no cost by visiting a pharmacy in MedImpact’s network and bringing the tests to the pharmacy counter. Members should present their member ID card and ask to have tests submitted to the insurance for coverage. Members can find a pharmacy online or call the Alliance at 800-700-3874.
• Members can continue to purchase tests online or in pharmacies and stores beyond November 11, 2023. They can be reimbursed up to eight at-home test kits per month and maximum of $12 per test. Visit the MedImpact website to request a reimbursement.

TotalCare members:

• OTC COVID-19 antigen tests are not covered under TotalCare. Members may obtain the tests under Medi-Cal benefit.

• Merced County
• Monterey County
• San Benito County.

There are no COVID-19 testing sites available in Mariposa or Santa Cruz counties. Please refer to the state’s COVID-19 Testing page for guidance on testing options.

There are several antiviral medications available to treat Covid-19, and more information can be found on the CDC’s Covid Treatment webpage.

Locate and order government-supplied treatments 

• 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.
  

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. 
• 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, view the following resources:

• COVID-19 Treatment Resources for Healthcare Providers
• Questions and Answers: COVID-19 Treatment Information for Providers and Facilities

Increase equitable access to COVID-19 treatments

COVID-19 disproportionately affects California’s most marginalized communities, as well as essential workers such as those in health care, grocery, and cleaning services. If this applies to your patient, here are resources for equity and reporting.

• Equity and reporting: Develop metrics and tracking systems to regularly review COVID-19 utilization data and identify disparities to help prioritize resources. Example metrics include:
  • Time from symptom onset to receipt of therapeutic.
  • Time from initial contact with member to receipt of therapeutic.
  • Member demographics accessing treatment, including: SDOH, race, ethnicity, zip code and age.
  • Percent of symptomatic and COVID-19 positive patients who are evaluated by a prescriber.
  • Percent of symptomatic and COVID-19 positive patients who receive a prescription for a therapeutic.
  • Reasons why a patient was not prescribed a therapeutic.

To learn more, see California's Commitment to Health Equity.

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 Alliance Provider Directory or contact your Provider Relations Representative.