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:

At-home COVID-19 tests are covered by Medi-Cal Rx, not the Alliance.

No-cost test kits from Medi-Cal Rx-enrolled pharmacies

Alliance members will need to go to a pharmacy that is enrolled as a Medi-Cal Rx pharmacy. Members should request tests at a pharmacy counter that accepts Medi-Cal Rx by requesting a consultation with the pharmacist on duty, presenting their Medi-Cal beneficiary identification card and requesting a COVID-19 OTC test based upon medical need. 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.

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 lossis hu rau Alliance ntawm 800-700-3874.
• Members can purchase tests online or in pharmacies and stores through 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.

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Several therapies have received approval from the Food and Drug Administration (FDA) or are available under an FDA’s Emergency Use Authorization (EUA). 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.
• COVID-19 Therapeutics Thresholds, Orders, and Replenishment
  

Billing

• Oral COVID-19 antiviral products nirmatrelvir/ritonavir (Paxlovid) and molnupiravir (Lagevrio) are purchased and provided by the federal government and distributed to pharmacy providers for free.
  • Pharmacies will be reimbursed for a professional dispensing fee by Medi-Cal Rx for Medi-Cal members. Refer to the Medi-Cal Rx provider manual kom paub ntau ntxiv.
  • For Alliance Care IHSS members, pharmacies will be reimbursed for a pharmacy dispensing fee by MedImpact. Contact MedImpact for more details at 800-788-2949.
• Remdesivir (Veklury) is commercially available. Providers may submit claims to the Alliance using an appropriate HCPCS code.

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, 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. Compared to the rate for all Californians:

• Death rate for Latino people is 8% higher.
• Case rate for Pacific Islander people is 82% higher.
• Death rate for Black people is 19% higher.
• Case rate for communities with median income <$40K is 14% higher.

Best practices for caring for uninsured patients and/or a patient new to your clinic or system:

• Lower barriers to seek urgent care for evaluation and treatment for COVID-19, including shortening or bypassing standard enrollment processes.
• Become a Medi-Cal Qualified Provider.
• 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, visit California's Commitment to Health Equity

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) Kev Nrhiav Chaw Kuaj Kom Kho Tus Kab Mob COVID-19 (Test to Treat) 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 Alliance Phau Ntawv Teev Cov Kws Kho Mob or contact your Provider Relations Representative.