CHICAGO -- Blue Cross Blue Shield Association (BCBSA) announced today that its network of 36 independent and locally-operated Blue Cross and Blue Shield (BCBS) companies will waive prior authorizations and increase coverage for COVID-19 as described below. Blue Cross and Blue Shield companies (BCBS) will also increase access to prescription drugs, enhanced telehealth and other clinical support systems. BCBS is making these changes to ensure its members can swiftly access the right care in the right setting during the outbreak. BCBS companies also stand ready to share data and expertise with local public health departments to support the needs of communities we serve.
The comprehensive steps taken by the BCBS companies mean that millions of Americans nationwide will have easier access to a range of medical services they may need should they become ill with COVID-19. The announcement mirrors the ongoing efforts of individual BCBS companies that remain committed to ensuring the better health of those in their local communities.
The full details of this coverage commitment include:
- BCBS will waive prior authorizations for diagnostic tests and for covered services that are medically necessary and consistent with CDC guidance for members if diagnosed with COVID-19
BCBS companies will also make dedicated clinical staff available to address inquiries related to medical services, ensuring timeliness of responses related to COVID-19.
- BCBS will cover medically necessary diagnostic tests that are consistent with CDC guidance related to the COVID-19 at no cost share to member
BCBS companies will cover, with no cost share to the member, the appropriate medically necessary diagnostic testing for COVID-19, where it is not covered as part of the Public Health Service response. Any care needed once diagnosis of COVID-19 has occurred will be covered consistent with the standard provisions of the member’s health benefits.
- BCBS will increase access to prescription medications by waiving early medication refill limits on 30-day prescription maintenance medications (consistent with a member’s benefit plan) and/or encouraging members to use their 90-day mail order benefit
BCBS companies will also ensure formulary flexibility if there are shortages or access issues. Patients will not be liable for additional charges that stem from obtaining a non-preferred medication if the preferred medication is not available due to shortage or access issues.
- BCBS will expand access to telehealth and nurse/provider hotlines
Given the nature of the COVID-19 outbreak, seeking in-person medical care may lead to further spreading of the virus. BCBS companies will encourage the use of virtual care and will also facilitate member access and use of nurse/provider hotlines.
“It is important that our members feel safe and secure knowing that they are able to pursue the proper care and testing they need to protect their health during this time of concern,” said Vincent Nelson, M.D., vice president, medical affairs and interim chief medical officer at BCBSA. “Whenever and wherever our members need health care related to the coronavirus, BCBS companies are right there with them.”
BCBS companies have significant experience handling previous international disease outbreaks including SARS and the Swine Flu and continue to work closely with local, state and federal governments during the coronavirus outbreak to ensure that members get the information, testing and care they need.
These actions will apply to fully-insured, individual, and Medicare members of the 36 U.S. and Puerto Rico-based BCBS companies. We are committed to working with state Medicaid and CHIP agencies to ensure that beneficiaries have access to needed testing and services.