ARI SHAPIRO, HOST:
After the holidays, Christine Izzo needed to find some COVID tests. Her 20-year-old son attends a university in Chicago, and her 18-year-old daughter is in a nursing program.
CHRISTINE IZZO: My son has a requirement for testing even to enter the campus. And my daughter has a weekly PCR test requirement.
SHAPIRO: No negative test, no school - that's the case for a lot of young people right now. Izzo herself can get tested through work. She's a nurse at Sharp Memorial Hospital in San Diego. But those tests are only for her.
IZZO: So midweek, I began searching.
SHAPIRO: Many of the testing facilities in her area were closed. Her local health care provider was only giving out tests to symptomatic patients. And she couldn't find any at the store.
IZZO: I called a number of pharmacies, grocery stores. They just were nowhere to be found.
SHAPIRO: Time was running out. Her son and daughter would need to be tested soon to get their results before their breaks ended. Then Izzo found a COVID clinic that had both PCR and rapid antigen tests available, but she'd have to pay.
IZZO: The rapid test was $125 out of pocket, paid in advance, and my daughter's PCR test with a report was $299. And I swallowed hard.
SHAPIRO: CONSIDER THIS - the price of admission to many public spaces now likely means the price of a COVID test. So why does the cost of testing vary so widely? And will the Biden administration's plans finally make them easier to access?
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SHAPIRO: From NPR, I'm Ari Shapiro. It's Wednesday, January 12.
It's CONSIDER THIS FROM NPR. Christine Izzo swallowed hard and paid the money - about $430 - for two COVID tests.
IZZO: I decided that this was really the only option for us because when you need answers, you need them in a timely manner.
SHAPIRO: And Izzo says she's blessed.
IZZO: I'm able to do it. You know, work a couple extra hours at work and cover that cost without a significant financial hardship to us. I recognize for other people that that means they wouldn't eat for a few weeks and that so many people just couldn't even bear the cost of that.
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SHAPIRO: The Biden administration announced new details this week about how over-the-counter COVID tests can soon be covered by insurance. Starting this weekend, insurance companies and health plans will be required to cover at least eight at-home tests per person per month.
TOM INGLESBY: And we're pulling all of the levers that are there to increase capacity.
SHAPIRO: I spoke to Dr. Tom Inglesby, senior adviser for testing on the White House COVID-19 response team. And I asked him how far there is still to go before everyone who wants access to tests can get them.
INGLESBY: There's obviously much more progress to be made. I think if you look back in the summertime, there were 25 million over-the-counter tests available in August. This last month, there were 300 million, so more than a tenfold rise. But we're going to keep pressing forward. We know there's much more work to do. And there will be a continued rise in the availability of over-the-counter tests in the months ahead, including...
SHAPIRO: A continued rise in the months ahead. But some of the forecasts say...
SHAPIRO: ...That omicron could spike within a month. So time is of the essence here. News that insurance will reimburse people for tests doesn't help those who can't find a pharmacy or drugstore to sell them a test. When do you think supply will meet demand?
INGLESBY: We know that pharmacies are restocking their shelves after the holidays, and numbers are beginning to trend up. And we will be getting more supply. There are more manufacturers that are authorized to make these tests. We saw - the last week of December, we saw two new major manufacturers get their authorization to make these tests, and they'll be beginning to ship those tests in the country in January. So we're hopeful that over the course of the month, people will find it easier and easier to get these tests after the holiday surge has passed us. But we're moving ahead on all fronts.
SHAPIRO: Once people do get a test, getting reimbursed from their insurance company is certainly better than paying out of pocket but that's still a potential inconvenience. I was in the U.K. for the global climate summit in November, and people were literally handing out free seven-packs of at-home tests on street corners. Do you foresee a time when the U.S. gets to where the U.K. is on this? Or is that even the goal?
INGLESBY: Well, you know, if you look around the world today, every country in the world right now is having difficulty meeting the demand in the middle of omicron. So headlines in the U.K. and countries around the world are similar to ours. People are very interested in these tests, and it's difficult to keep up with demand. But I do foresee a time where it will be much easier to access over-the-counter tests. There are more suppliers that are likely to come online in January - more manufacturers. And the president's 500 million antigen test distribution plan that he announced right before the holidays - that is a major spur for the market around the world to make more and more tests. And this - the plan we announced today regarding insurance also will indicate to the market that they will be paid for, and they will - this will be an ongoing demand for them. And this will spur the market as well.
SHAPIRO: Dr Tom Inglesby, senior advisor for testing on the White House COVID-19 Response Team.
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SHAPIRO: It'll still take time to manufacture and distribute those 500 million free tests. The Biden administration has signaled that a website to request them may be online as soon as this weekend. In the meantime, people who need negative COVID tests to go to school or work find themselves at the mercy of a booming multibillion-dollar industry.
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SHAPIRO: According to one study of prices at hospitals, a COVID-19 test could cost anywhere from $20 to $1,400. So why is there such a drastic difference in prices of tests? Well, I put that question to Adam Tanner, who wrote about this for Consumer Reports.
ADAM TANNER: Well, it's hard to answer directly this question, and that is because you have to have to have the raw materials, and then you need a machine that can be from thousands of dollars to hundreds of thousands of dollars, depending how many tests it does. At the time, you've got to pay the staff, the utilities and so on, but the raw cost of the test itself, the raw materials, are rather low. They can be as low as $29. So the actual cost is not that high, but companies will disagree as to what the true cost should be.
SHAPIRO: Does that explain the wide range in prices, or is there more going on here?
TANNER: The wide range of prices is pretty much explained by the fact that it is an open, free market with medicine, as it is in almost everything else in the United States. So the same way as car prices will go up and down according to supply and demand, it happens with medicine. It happens with testing. So under the U.S. government rules, insurers have to pay for medically necessary tests, no matter what the price, when it comes to COVID. So that means if they charge an average $100 or $150, that's OK. If the test lab thinks they need several tests in unison, perhaps raking up a bill of as high as $1,000, that is also allowed under the U.S. rules, and insurers are supposed to pay.
SHAPIRO: So why are we seeing people pay hundreds of dollars out of pocket?
TANNER: So the rules are if they are medically necessary tests - that means either you have COVID or you've been exposed to someone that has COVID - those tests are covered by the U.S. rules, covered by your insurance company. If, however, they're not medically necessary - you want to go traveling to a place that requires a test. You want to go to a concert. You want to go to - back to your work, and your work requires it - then you have to pay. Those are considered non-medically-necessary tests. And again, there's a very wide range of prices, from zero at community centers, at health centers, various hospitals, to hundreds and hundreds of dollars, whatever these new testing centers may want to charge. So it pays to check what those prices are.
SHAPIRO: How profitable is this for testing companies?
TANNER: Well, the big medical testing labs and companies are making literally billions of dollars, so it is a very big business. Now, of course, this is an essential service. We should be really thankful for the people who, on the ground, are doing this testing on the frontlines. But there's big money when combined, and the biggest makers of this big money are the big companies that do the testing, that do the medicine.
SHAPIRO: You also write that the current U.S. rules allow for-profit pop-up sites offering simple rapid tests to operate without any experience in health care or science. What are the implications of that?
TANNER: Well, so when we think of testing labs, you might imagine someone in a lab coat working with test tubes and studying scientific instruments. But there, of course, are these easy tests that we know as at-home tests. They're simple enough that anybody can do them at home, buy them over the counter or the internet. So if you set up a testing counter on the street in a van, these are simple enough where it is hard to make a mistake. These are labs or operations that are allowed to operate, waiving the usual federal government rules.
That means pretty much anyone can do it, so it could be a very reputable operation. It could be someone with no experience in medicine or health care. And there are many people who've entered the market. So again, it's this balance. The more people offering testing, this is an important, valuable service for the nation at this time. But at the same time, if they're charging high prices, that may be hurting us to a certain extent. And this is part of that dilemma of testing.
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SHAPIRO: Adam Tanner is a contributing editor to Consumer Reports and an associate at the Harvard Institute for Qualitative Social Science. Thank you very much.
TANNER: Thank you.
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SHAPIRO: It's CONSIDER THIS FROM NPR. I'm Ari Shapiro.
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