On January 20, 2022, the National Supplementary Health Agency (“ANS”) published Rule No. 478, of January 19, 2022 (“RN No. 478/2021“), which amends Rule No. 465, of February 24, 2021 (“RNº 465/2021”) and obligates healthcare plan operators to pay for COVID-19 rapid antigen tests.
Regarding the new measure, we highlight the main aspects and requirements:
- Coverage for this test becomes immediate from January 20, 2022;
- The COVID-19 rapid antigen test included in the list of health plans coverage must be carried out exclusively in laboratories. Tests carried out in pharmacies are not covered.
- Coverage will be mandatory for patients with Influenza Syndrome (GS) or Severe Acute Respiratory Syndrome (SARS), between day 1 and 7 from the onset of symptoms, as requested by a doctor;
- The test will be covered for health plan beneficiaries with outpatient, inpatient or referral segmentation;
- ANS does not guarantee coverage of rapid test expenses to: (a) Those with asymptomatic contact with a confirmed case; (b) Individuals up to 24 months of age; (c) Individuals who have been tested (RT-PCR or rapid test for antigen detection for SARS-CoV-2) within the last 30 days, and the result was positive; and (d) Individuals whose prescription has the purpose of monitoring illness, returning to work, controlling healing, or discontinuing isolation;
- Medical requests that meet the conditions established in the Usage Directive (DUT) must be authorized immediately.
Demarest’s Life Sciences team is available should you need any further clarification on this matter.