The public health emergency related to the COVID-19 pandemic ended on May 11, 2023. This means that certain rules put in place during the pandemic are no longer in effect.

Testing

Point of care tests

Beginning May 12, 2023, health care providers will begin collecting cost-share (copays, coinsurance, and deductibles) for COVID-19 tests performed in a health care provider practice or at a pharmacy.

Cost-share will apply to all point of care tests (including rapid tests) that have been determined to be medically appropriate by an attending provider or pharmacist, and when testing is approved by the FDA or issued an Emergency Use Authorization (EUA). Testing ordered or requested by someone other than an attending provider, or performed without an order, including testing on asymptomatic individuals as required by employers, schools, camps, and epidemiological research, or for the purpose of travelling to and from New York state, is not covered.

This coverage change does not apply for CDPHP Medicaid or HARP members who will continue to receive point of care tests at no out-of-pocket cost under their pharmacy benefit, which is administered by the New York State Department of Health as of April 1, 2023.

This coverage change does not apply for Child Health Plus or Essential Plan members who may continue receiving point of care tests at no out-of-pocket cost through September 30, 2024.

Members of self-funded groups can call the number on their ID card for cost-share information.

Federal Employee Health Benefit (FEHB) members learn more.

At-home tests

At-home tests are considered an over-the-counter product. Therefore, members will pay the retail price for at-home tests beginning May 12, 2023. Members with health funding accounts, such as an FSA, HRA, or HSA, can use these funds to pay for at-home tests.

This coverage change does not apply for CDPHP Medicaid or HARP members who will continue to receive point of care tests at no out-of-pocket cost under their pharmacy benefit, which is administered by the New York State Department of Health as of April 1, 2023.

This coverage change does not apply for Child Health Plus members who may continue receiving two FDA-authorized COVID-19 test kits, per week, with no cost-sharing through September 30, 2024. Covered “at home” test kits must be authorized by the FDA for use in both symptomatic and asymptomatic patients and allow for self-collection without medical observation.

This coverage change does not apply for Child Health Plus or Essential Plan members who may continue receiving two FDA-authorized COVID-19 test kits, per week, with no cost-sharing through September 30, 2024. Covered at-home test kits must be authorized by the FDA for use in both symptomatic and asymptomatic patients and allow for self-collection without medical observation.

Members of self-funded groups can call the number on their ID card for cost-share information.

Federal Employee Health Benefit (FEHB) members learn more.

Antibody tests

Beginning May 12, 2023, cost-share will apply for COVID-19 antibody testing. While there is no limit on the number of antibody tests that can be ordered, we are relying on the ordering provider to determine medical necessity.

Members of self-funded groups can call the number on their ID card for cost-share information. 

Federal Employee Health Benefit (FEHB) members learn more.

Vaccines

CDPHP will continue to cover COVID-19 vaccines when administered by an in-network provider or pharmacy at no out-of-pocket cost. Please note that cost-share will apply for vaccines administered by out-of-network providers.

Medicaid and HARP members are covered by CDPHP when the COVID-19 vaccine is administered by an in-network provider. Vaccines received at the pharmacy are covered under the pharmacy benefit, administered by the New York State Department of Health as of April 1, 2023.

Note: COVID-19 vaccines are available to members younger than 19 years of age through the Vaccines for Children (VFC) program. Pediatric members can obtain vaccines at a VFC provider, such as a practitioner’s office, public health clinic, or county health department. Pharmacies may not bill Medicaid for the cost of vaccines that are available through the VFC program but may administer vaccines if the pharmacy is enrolled in the program.

Members of self-funded groups can call the number on their ID card for cost-share information.

Federal Employee Health Benefit (FEHB) members learn more.

Treatment

For services rendered on or after October 20, 2022, in accordance with NYS guidelines, cost-share (copays, coinsurance, and deductibles) will apply for COVID-19 related treatment.

This change applies to oral antivirals (such as Paxlovid) used to treat COVID-19. This does not apply to CDPHP Medicare Advantage members who will continue to receive oral antivirals with no out-of-pocket cost when prescribed by an in-network provider through the end of 2024.

This coverage change does not apply for CDPHP Medicaid or HARP members who will continue to receive prescribed treatment at no out-of-pocket cost under their pharmacy benefit, which is administered by the New York State Department of Health as of April 1, 2023.

Members of self-funded groups can call the number on their ID card for cost-share information.

Federal Employee Health Benefit (FEHB) members learn more.