At home testing can empower patients and improve outcomes

December 5, 2023

Until 1976, the only way a person could get a pregnancy test was to go to a provider office or an emergency room. The marketing of home pregnancy tests helped many women determine if they were pregnant without an expensive medical visit. We saw the same pattern during the COVID-19 pandemic.  During the first year of the pandemic, our nasal swabs were sent to complex labs to determine whether we were infected with COVID. By 2021, at-home tests gave us rapid and accurate results, helping prevent many secondary infections.

The world of at-home tests continues to expand. At-home testing can give quicker answers, help reduce strain on the medical and pharmacy system, and allow for earlier diagnosis. Here is what is most promising:

1. HIV testing

○      Home HIV tests can be done in less than 30 minutes at home- or can be mailed to a lab. Offering testing in private can help prevent secondary infections, and help us achieve the US goal of 90% decrease in new HIV infections by 2030.

○      Home testing can help to monitor those on Pre-exposure Prophylaxis (PrEP), who should be tested for HIV every three months.

2. Home tests for other sexually transmitted infections (STIs)

○      The Food and Drug Administration (FDA) just approved an at-home urine or swab to test for the two most common sexually transmitted diseases, chlamydia and gonorrhea. The test is mailed in, so results take a few days. Those who were exposed to STIs or have symptoms should be seen by a provider promptly and generally treated regardless of the results of tests. Hopefully, the next generation of tests will give results at home.

3. Home HPV (human papillomavirus) tests  

○      This is not yet FDA approved for cervical cancer screening, although HPV tests are gradually replacing traditional pap smears for this purpose.

4. Home screening tests for colorectal cancer

○      Fecal Immunochemical Tests (FIT tests) are effective at screening for colorectal cancer, and recommended by the US Preventive Services Task Force as one alternative to colonoscopies for those between ages 45 and 75. They should be performed annually, and require no colon prep. They are substantially less expensive than other methods of screening for colon cancer, including colonoscopy, CT colonography, and Cologuard tests.

○      As with all at-home tests, inadequate samples require retesting.

5. Upper respiratory disease

○      Provider offices currently to point-of-care testing for strep throat, influenza, RSV and COVID-19, and these can be purchased online, although are sometimes only available in large quantities.

Implications for employers:

-    At home tests could help empower patients and make earlier diagnoses for infectious diseases.

-    Most insurance plans will not provide coverage for at-home tests, although the out-of-pocket costs of these are often less than the cost of an office visit so many health plan members will choose to self-pay for these.

-    Employees can check with their FSA or HSA administrators to understand if these OTC items are reimbursable.

- FIT tests are a promising way to increase screening rate for colorectal cancer.

Thanks for reading.  You can find previous posts in the Employer Coverage archive

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Tomorrow: Expensive new post-partum depression pill approved