In the days since the Biden Administration announced on January 15 that insurers would be required to cover eight over-the-counter Covid-19 tests per month for members, digital health company Truepill has been busy developing a platform to help health plans meet that mandate.
In May, the San Mateo, California-based startup, which provides pharmacy fulfillment and telehealth services for brands like Hims, Nurx and Lemonaid, added home testing. Co-founder and President Sid Viswanathan said in an earlier interview that the company had planned to also offer diagnostics from the beginning.
The Covid-19 test coverage platform will give clients a behind-the-scenes partner who can assist with everything from checking member eligibility for coverage of tests to delivering those tests to their homes and providing shipping updates en route.
“We found a lot of plans are having to react to this on very short timelines, and so we’re building out a white-labeled, e-commerce experience that a plan can utilize,” said Varun Boriah, senior vice president of diagnostics at Truepill, in a phone interview. “We can put any plan’s logo on that asset and manage their patient experience for them.”
The Biden Administration is incentivizing health plans and insurers to set up a network of convenient locations, such as pharmacies and retailers, where people who are insured can access tests without having to submit claims for reimbursement. The federal government created a website, covidtests.gov, where people can access free Covid-19 tests, and has enlisted the U.S. Postal Service in delivering those for free.
“While the government is working on the distribution of free tests through USPS, and that’s one great channel to ensure both access and affordability, the program through health plans to ensure tests get covered is the second avenue to hit those two goals,” Boriah said.
A Deep-dive Into Specialty Pharma
A specialty drug is a class of prescription medications used to treat complex, chronic or rare medical conditions. Although this classification was originally intended to define the treatment of rare, also termed “orphan” diseases, affecting fewer than 200,000 people in the US, more recently, specialty drugs have emerged as the cornerstone of treatment for chronic and complex diseases such as cancer, autoimmune conditions, diabetes, hepatitis C, and HIV/AIDS.
OTC Covid-19 tests have been in short supply and flown off pharmacy shelves recently during the Omicron surge and at other times during the pandemic. But Truepill has existing relationships with manufacturers and distributors, so it has had a continuous supply of Covid testing inventory.
“We haven’t had any disruptions to our supply chain,” Boriah said, a remarkable statement given the noticeable disruptions in business and shopping overall.
Truepill is responsible for the cost of acquiring the test from the market, processing the order and shipping it to the patient. In return, it receives reimbursement from health plans and pharmacy benefit managers.
In addition to the federal government, numerous states coast to coast are also providing free Covid-19 home tests, from Washington and Colorado to Iowa and New Jersey, and some cities like New York City and Boston are distributing the tests as well. Major retailers from CVS to Kroger to Amazon are also making it easy to order Covid-19 tests online though consumers still need to go through insurers to get reimbursement.
In addition to the Covid test coverage platform, Truepill has a Covid-19 testing platform and a Covid-19 virtual care platform offering on-demand telehealth consults along with next-day home delivery of Covid-19 oral antiviral medication.
“We’re really looking at bringing a number of different tools to this effort to get us past the pandemic,” Boriah said.
Photo: VioletaStoimenova, Getty Images
