By August Barham

Feb. 25, 2022

 

It was just after Christmas in Brevard, North Carolina, and Rebekah Dobbins, 21, was on a mission.

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Her mission: to find a COVID-19 test in time to spend New Year’s Eve with her friends. The clock was ticking, and every lab appointment was booked. Dobbins spent days scoping out her local pharmacies, waiting for the moment an at-home test would grace the empty shelves. Just when she was about to lose hope, she heard that Gordon's Family Pharmacy had received a new batch of tests. Dobbins jumped in her car, drove to the pharmacy, hurried down the crammed aisles, snatched up the precious test, saw the price tag, set the precious test back down and went home.

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“There was an at-home test that was $10 at Walgreens and then the exact same one was $30 at Gordon's Family Pharmacy, and only Gordon's Family Pharmacy had it,” said Dobbins, a site manager at Tidal Wave Auto Spa.

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As the United States reopens amid the pandemic, the costs and scarcity of PCR and Rapid Antigen COVID-19 tests are preventing many Americans from achieving a comfortable new normal. COVID-19 testing is supposed to be free with insurance, but extra fees related to supply and demand, manufacturing, production costs and more hurdles keep testing financially out of reach for some.

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“The antigen tests that are available are so much more expensive in the U.S. than in many other countries,” said Dr. Jens Rueter, chief medical officer of The Jackson Laboratory, a biomedical research institution based in the United States.

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At-home COVID-19 tests vary in price between manufacturers and retailers, with most single and double packs ranging from $10 to $25. Jeannine Mason is the director of marketing communications at Quidel, a health care manufacturer based in California. Mason says that the price of Quidel’s QuickVue® At-Home Rapid Antigen test is based on factors such as supply costs, manufacturing costs, labor costs, and, ultimately, the retailers. However, Mason says that Quidel attempts to keep tests affordable.

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“We want to stay competitive with the other products on the shelf and also keep it in a price point that does make it accessible to as many people as possible,” Mason said. The cost of QuickVue tests generally sits around $25 for a pack of two.

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Testing plays a pivotal role in the re-opening of society during COVID-19 and has become a common requirement for travel, events and other day-to-day activities. This means that high prices can prevent people from participating in the new world. Nikki Parker, 43, lives in Brevard and is a Parent Program Supervisor at the local children’s welfare nonprofit, The Family Place. Parker says that because she and her husband are uninsured, they usually opt to pass on events or preemptively quarantine instead of paying out of pocket for an expensive test.

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“If I went and got tested, even if it was positive, I'm going to do the same thing anyway,” Parker said. “If I felt sick, if I had the flu, I'm just going to stay home until I get better. So, I guess that's how I save money because I would have to pay for it out of pocket.” Parker said that while The Family Place was understanding of her situation, she imagines uninsured people whose employers require proof of a test could face a major problem.

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For those with health insurance coverage, COVID-19 testing is supposed to be free. On Dec. 2, 2021, the Biden Administration announced that private insurers had to reimburse people for costs of rapid at-home COVID-19 tests. Under the Families First Coronavirus Response Act, private insurance companies are also required to fully cover all PCR lab tests. However, insured people still find themselves facing miscellaneous charges related to testing. Once, Dobbins was elated to have found an open appointment for a PCR lab test at a local doctor’s office. She went in expecting that her insurance would be paying, but a few weeks after her appointment, she received a hefty co-pay bill in the mail.  

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“I don't think doctor's offices or hospitals should be able to charge any type of fee for you coming in and visiting them,” Dobbins said. “They aren't charging for the COVID test, but they are charging for a visit. So, you’re still getting charged.”

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Some health care providers that do not charge administration fees will instead charge based on how quickly patients can receive their results. At the Georgetown, Washington, D.C. location of the health care provider Sameday Health, a COVID-19 test with a 48-hour turnaround is fully covered by the patient’s insurance. However, for a 16-hour turnaround patients are charged $75 out of pocket.

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“Our company sets the prices to give our clients the cheapest possible prices while focusing on the best experience and highest quality tests for the most accurate results,” said Rachel Sutton, Sameday Health communications manager.

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High demand for COVID-19 tests has also strained supply chains and made the availability of testing a concern for people across the nation, particularly those in rural areas. The burden of locating these scarce tests remains on the shoulders of the individual.

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 “Supply chain issues have been really widespread, and it started with basic stuff like you didn't have the reagents to run the PCR—those, what I would consider, basic chemicals,” said Rueter, chief medical officer of The Jackson Laboratory. “I think what's the issue now is the availability of that readily accessible tests that you go to the pharmacy and buy.”

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Mary Yelverton is a 21-year-old Contracts Representative at ICON plc living in Eureka, North Carolina—a rural town with a population of 187, according to the United States Census Bureau’s 2019 data. Yelverton says that before worrying about the price, simply locating a test in Eureka is nearly impossible. “When my family and I had COVID, we couldn't even find out if we really had it and the only one who could get tested was my mom because she's in with the other nurses,” Yelverton said.

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Experts seem to agree that, as the United States acclimates to a new normal in which COVID-19 is a long-term fixture, efforts to make tests widely available and affordable are imperative on an individual and public health level. However, there is some discord concerning the best method for mass distribution of affordable tests. As Sarun Charumilind, Matt Craven, Jessica Lamb, Shubham Singhal and Matt Wilson wrote in the article, “Pandemic to Endemic: How the World Can Learn to Live with COVID-19,” published by Mckinsey & Company on Oct. 28, 2021, “Ubiquitous, frictionless access to testing for all members of society, especially those at higher risk, has proven effective at blunting transmission. What, exactly, this should look like is up for debate but should be available through a wide range of channels.”

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The Biden administration has attempted to provide free and accessible at-home COVID tests to all Americans by allowing households to order four tests to be shipped to their address. However, the four-test limit could mean that some households will wait months to receive tests that will last them days. Dobbins says she is happy to be getting the tests but is wary of their efficacy.

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“I don't really trust at-home tests,” Dobbins said. “I'll use them just because they're the cheaper option, but if I could, I would prefer to have the PCR test.”

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Rapid Antigen COVID-19 tests vary in accuracy. A CDC study published on Jan. 22, 2021, found that the BinaxNOW Rapid Antigen Test is about 85% accurate in detecting positive cases. Rueter says that, despite their margin of error, the Rapid Antigen tests are effective at catching the most highly infectious cases. He, therefore, suggests that the U.S. focus less on developing highly sensitive tests but rather focus on addressing distribution discrepancies.

 

“I think we can forgo highly sensitive tests if that means we can make less sensitive tests available to more people,” Rueter said.

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Rueter predicts and suggests a few future innovations to the United States test distribution system in order to overcome availability issues. One such innovation that could be potentially significant is the use of wastewater to detect COVID-19 outbreaks.

 

“You can also do wastewater testing, which is really the new thing that's up and coming now and I think that's also going to remain critical,” said Rueter. “Then you can much more easily and economically monitor communities and identify, 'is there something going on that's above the background noise?'”

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As politicians, medical researchers and test manufacturers debate the best test distribution, most Americans continue to use their own investigation and judgment to determine when and how to get an affordable test. Dobbins says that considering many employers now require a COVID test before employees can take sick leave or return to work, testing should be available free of charge.

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“I feel like tests shouldn’t cost anything,” Dobbins said. “America claims to be one of the top countries but then they’re not providing healthcare.”