On Nov. 21, 2022, HHSC added two new COVID-19 test kit national drug codes (NDCs) to the formulary as a reimbursable pharmacy benefit in the Medicaid, the Children’s Health Insurance Program (CHIP), the Healthy Texas Women (HTW), the Kidney Health Care (KHC) program, and the Children with Special Health Care Needs (CSHCN) Services Program.
HHSC added the following COVID-19 at-home test kits to the formulary:
|Genabio antigen test||96852025431||1 test|
|Genabio antigen test||96852095300||2 tests|
Clients are allowed a maximum of four COVID-19 tests per calendar month. There is no dispensing, delivery, or incentive fees on COVID-19 at-home test kits.
The list of covered test kits and their respective NDCs is available as part of the Formulary Product search on the Vendor Drug Program website. Test kits do not count against a fee-for-service (FFS) Medicaid client’s three-prescription-per-month limit.
HHSC reject FFS Medicaid, HTW, KHC, and CSHCN Services Program pharmacy claims exceeding the maximum quantity of four tests per calendar month with NCPDP reject code “76” (plan limitation exceeded) and the message “Only 4 COVID-19 tests allowed per calendar month” in the “Additional Message Information” field (526-FQ).