Frequently Asked Questions

Viruses can change over time from the original virus, making it more likely that the virus will continue to spread, according to the CDC. Some variants can be mild. Others can cause more infections and make the virus spread faster. There are currently two prevalent variants of COVID-19, the Delta and Omicron variants.

Getting vaccinated remains the best way to prevent catching COVID-19 or having a severe case, the CDC says. It’s also important to continue to follow the CDC’s recommendations on preventing the spread of COVID-19, including social distancing, frequently washing your hands, cleaning surfaces with disinfectant and using antibacterial hand sanitizer often.

While the vaccine is your best protection against the virus, it isn’t full proof when dealing with variants. No vaccine is 100% effective. That’s why boosters are available and recommended for people who have been vaccinated.

If you are having symptoms or have been exposed to COVID-19, you should take a COVID-19 test to be diagnosed.

If your test is positive, contact your doctor’s office so they can manage your care and recovery. If your test is negative but you are sick, your doctor may want to test you for other illnesses that have similar symptoms, such as the flu, strep or a stomach virus.

Until you know if you are contagious, the CDC recommends you isolate yourself from those you live with and not go to work, school or community and family events.

The CDC offers up-to-date quarantine and isolation guidelines, based on current data.

You have options, including self-testing at home, testing at a pharmacy or testing lab, even some doctor’s offices offer testing. Make sure you use doctors, pharmacies and labs in your health plan’s network for maximum benefits. Learn more about your testing options.

Check your Benefit Booklet to find out if you can get FDA-authorized, over-the-counter COVID-19 tests for diagnosing COVID-19 through your BCBSNM/Prime Therapeutics® pharmacy benefits. And if you use a pharmacy in Prime’s network and check out at the pharmacy counter, you may not have to pay upfront or submit a claim for reimbursement. View a list of pharmacies in Prime’s BCBSNM network or in Prime’s national network.

If an in-network pharmacy can’t submit your claim electronically for some reason, you can submit a reimbursement request.

For other pharmacies, you may have to pay for the test and submit a claim to be reimbursed. If you don’t have pharmacy benefits with BCBSNM/Prime, contact your health plan administrator for information about getting test kits, coverage and being reimbursed.

For those with BCBSNM pharmacy benefits through Prime Therapeutics, your plan may cover the cost of FDA-authorized, over-the-counter diagnostic tests. Your benefits may cover up to $12 per test, up to 8 tests every 30 days per person. (For example, you can purchase 4 boxes that include 2 over-the-counter COVID-19 tests.)

Claims for all over-the-counter COVID-19 tests purchased at the pharmacy counter or submitted for reimbursement will be reimbursed up to $12 per test if covered by your benefits.

If you aren’t sure if a test kit is FDA-authorized, ask your pharmacist for help.

Eligible members can also order up to 8 at-home COVID-19 tests every 30 days from Express Scripts® Pharmacy with no up-front costs. Log in or register to place your order, or call 1-833-715-0942. Supplies may be limited, and tests may take longer to arrive.

Over-the-counter tests for things like return to work or school, travel and recreational event requirements may not be covered unless you have symptoms or have been exposed.

You may be able to request free OTC tests through the federal government’s site. According to the site, the nation’s stockpile of at-home tests has not been replenished.

Coverage of testing, vaccines and treatment will vary based on your plan, and coverage related to COVID-19 can change. Go to What’s Covered for the most up-to-date information.

Visit the What’s Covered section to learn more about your coverage. The Centers for Disease Control and Prevention (CDC) offers up-to-date health information about COVID-19. Our Connect blog has numerous articles about COVID-19 prevention, testing, treatment and coverage.

Check your Benefit Book to find out if you can get FDA authorized over-the-counter COVID-19 tests for diagnosing COVID-19 through your BCBSNM/Prime Therapeutics^® pharmacy benefits. And if you use a pharmacy in Prime’s network and check out at the pharmacy counter, you may not have to pay upfront or submit a claim for reimbursement because your pharmacy benefits will cover the cost of up to 8 FDA-authorized tests every 30 days per person. View a list of pharmacies in Prime’s BCBSNM network or in Prime’s national network.

If you don’t use a pharmacy in Prime’s network, your benefits may cover up to $12 per test, up to 8 tests every 30 days per person. (For example, you can purchase 4 boxes that include 2 over-the-counter COVID-19 tests.)

Claims for over-the-counter COVID-19 tests submitted for reimbursement will be reimbursed up to $12 per test if covered by your benefits.

Over-the-counter tests for things like return to work or school, travel and recreational event requirements may not be covered unless you have symptoms or have been exposed.

Please review the response to the previous question. Additionally, if an in-network pharmacy can’t submit your claim electronically for some reason or you didn’t purchase your tests from an in-network location, you can submit a reimbursement request.

Eligible members can also order up to 8 at-home COVID-19 tests every 30 days from Express Scripts^® Pharmacy with no up-front costs. Log in or register to place your order, or call 1-833-715-0942. Supplies may be limited, and tests may take longer to arrive.

You may be able to request free OTC tests through the federal government’s site. According to the site, the nation’s stockpile of at-home tests has not been replenished.

Here is the national network pharmacy list.

For those with BCBSNM pharmacy benefits through Prime Therapeutics, your pharmacy benefits may cover the cost of FDA-authorized, over-the-counter diagnostic tests. You will be reimbursed up to $12 per test, up to 8 tests every 30 days per person, if covered by your benefits. (For example, you can purchase 4 boxes that include 2 over-the-counter COVID-19 tests.)

You can purchase the at-home test kits for diagnostic purposes. Over-the-counter tests for things like return to work or school, travel and recreational event requirements may not be covered unless you have symptoms or have been exposed.

If you don’t have pharmacy benefits with BCBSNM/Prime, please contact your health plan administrator for more information.