I have a similar question. What if a plan has not established a direct coverage arrangement (or an “adequate” direct coverage arrangement) and, as a result, can rely on the $12 reimbursement limit for eligible tests purchased from non-preferred pharmacy/retailer. I’m this situation does the plan have to reimburse shipping costs for tests for these tests purchased at non-preferred pharmacies/retailers.
I am also aware of insurers/PBMs refusing to reimburse eligible tests obtained from “third party” sellers (e.g., Amazon, EBay, etc) because those tests are usually much more expensive due price gouging or supply/demand market influences. I see the logic foe this and I see why it may be a defensible position, but I don’t see any support for it in the FAQs.
