MDH ADVISORY No. 260 COVID-19 Home Test Kit Coverage (2024 UPDATE)

This Advisory is an update to Advisory 251.
Please note that this will be the last published update identifying which COVID-19 Home Test
Kits are covered. Going forward, Maryland Medicaid will update coverage when new products
that meet requirements are identified, without issuing notification to pharmacies.

Testing is vitally important to help reduce the spread of Coronavirus-2019 (COVID-19) and to
diagnose COVID-19 quickly so that it can be effectively treated. Over-the-Counter (OTC)
diagnostic SARS-CoV-2 antigen tests for home use are convenient, efficient, and accurate in
rapidly detecting the presence of certain proteins on the surface of the virus that causes
COVID-19.

This Advisory applies to Participants enrolled in the Maryland Fee-for-Service (FFS) program
and Participants enrolled in Managed Care Organizations (MCOs) that participate in the
Maryland HealthChoice Program.

Effective September 11, 2023, Maryland Medicaid Fee-For-Service (FFS) expanded access to
Food and Drug Administration (FDA) Emergency Use Authorized (EUA)and/or FDA
authorized a OTC COVID at-home tests for Maryland Medicaid Participants

Maryland Medicaid covers a maximum of four tests every rolling 30 days. Tests may be
selected from the list in the Table 2 and mixed and matched between kits for a total of four
tests. Coverage of additional test kits exceeding the quantity limit described above will
require prior authorization. Participant copayment will not apply. Table 2 has been updated
with the current FDA Authorized and/or FDA Approved OTC COVID at- home tests as of April
11, 2024.

The ninth amendment to the COVID 19 PREP Act Declaration provides liability immunity to
licensed pharmacists and expands the scope of authority for them to order and administer
select COVID 19 therapeutics to populations authorized by the FDA. If the participant does not
have an order from a prescriber, prior to ordering an OTC COVID-19 at-home test, the
pharmacist shall gather and document the following information and retain it in the record
just as any other prescription:
a. Participant’s Name and Date of Birth,
b. Participant’s Medicaid Identification number,
c. Reason for a test (such as COVID-like symptoms, COVID exposure), and
d. Date of symptom onset or date of known COVID exposure, as appropriate