December 2, 2021

On Thursday, December 2nd, the President Biden announced new actions to improve the rate of booster uptake, avoid shutdowns, and prepare for a winter COVID-19 surge. This all comes on the heels on the newly identified Omicron variant.

What it is

This plan includes (note these categories are from the administration):


  • Boosters for All Adults


Remember that CDC changed its booster recommendations earlier this week to include all individuals over 18. The administration is doubling down efforts to convince Americans to get them, including – 

  • Expanded hours and outreach to Americans from federal pharmacy partners. 
  • A notice from Medicare to 63 million seniors to encourage boosters.
  • A campaign with AARP to encourage older Americans to get boosted through town halls, rides to booster clinics, and education events across the country, focusing on those at highest-risk.  
  • Requesting that employers provide paid time off to their employees to get vaccinated and boosted: All federal employees currently receive paid time off to get booster shots. Remember, that requiring paid time off was part of the OSHA emergency temporary standard (ETS), but that is tied up in court. 



  • Vaccinations to Protect Our Kids and Keep Our Schools Open
  • Launching “family” vaccination clinics where people of all ages can get their vaccines and/or boosters at the same time and in the same place, including:  


    • The Health Resources and Services Administration (HRSA) will launch Family Vaccination Days – with community health centers across the country hosting family vaccination clinics throughout December.
    • FEMA will launch Family Mobile Vaccination Clinics, deploying sites, staff, and support to states across the country that need help – beginning with its first deployments to Washington and New Mexico.
    • States and localities will receive federal funding and new information about how to establish location to provide access to vaccines for all ages.
    • Federal pharmacy partners will launch “family-based scheduling” to allow families to get their vaccinations all at once.
  • Require Medicaid programs to pay providers for vaccine consultations (with 100% federal match for the services).
  • Reviewing CDC’s COVID-19 recommendations for schools to potentially revise the current policy of a 14-day quarantine at-home for unvaccinated close contacts of a known COVID-19 case. The CDC is examining results from state “test to stay” policies (whereby kids stay in school but test daily after a known exposure in the classroom) and release findings “in the coming weeks.”
  • Issuing a new “Safe Schools Checklist” to all K-12 schools, detailing a set of actions that every school can take to get their staff and students vaccinated.
  • Support FDA in its review of data to support authorization of the COVID-19 vaccines in kids under 5. 



  • Expanding Free At-Home Testing for Americans


    • Requiring insurers to cover at-home COVID-19 tests. HHS, DOL and the Treasury (the “tri-agencies” in charge of health care coverage) will issue guidance by January 15th to clarify that individuals who purchase an OTC COVID-19 can seek reimbursement from their plan during the public health emergency. The press reports that this coverage will not be retroactive. 
    • Doubling the commitment from September to distribute 25 million free tests to community sites to 50 million tests and will add rural clinics to the program



  • Stronger Public Health Protocols for Safe International Travel


    • Inbound international travelers to the United States will be required to show a negative COVID-19 test within one day of departure, regardless of vaccination status. The press has reported that rapid tests will be allowed to meet this requirement.
    • Masking requirements for air, rail, and public transportation will be extended to March 18, 2022, with fines for non-compliance will be increased to $500-$3000 (for repeat offenders).



  • Protections in Workplaces to Keep Our Economy Open


    • Requesting that businesses implement testing and vaccination requirements along the lines of the OSHA ETS.



  • Rapid Response Teams to Help Battle Rising Cases


    • New emergency response teams will be available to help supplement state efforts. These teams include:
      • 20+ Department of Defense Medical Response Team deployments to support clinical staffing at strained hospitals.
      • 10 National Disaster Medical System team deployments to provide clinical support at strained hospitals.
      • 20+ monoclonal antibody strike team deployments to support the administration of these lifesaving treatments.
      • 15+ CDC expert deployments to conduct outbreak investigations and provide epidemiological or technical support whenever needed.
  • $20 million in funding from the American Rescue Plan to strengthen the Medical Reserve Corps (MRC) by providing additional resources needed to support the roughly 300,000 MRC professionals around the country.
  • HHS will also lead a national effort to mobilize volunteers, including retired doctors and nurses, in areas with rising COVID cases.



  • Supplying Treatment Pills to Help Prevent Hospitalizations and Death


  • “Securing” 13 million doses of antiviral courses to ensure an ample supply (the Administration notes this is six times the number of total hospitalizations this year). How these products will be deployed and who will be eligible is not yet clear. Some of those decisions will depend on the scope of the Emergency Use Authorization’s which are yet to be granted to either of the late-stage products. 
    • Note that CMS has already provided some guidance on how providers will be paid for dispensing these pills under Part D once available.



  • Continued Commitment to Global Vaccination Efforts
  • The administration notes that the US has donated 1.2 billion doses to the world, or for every one shot administered, we’ve donated about three. It also notes that it is working to expand the supply of critical ancillary needs like syringes. It pledges to 200 million more doses in the next 100 days to “countries in need” for free. The US is also the first country to negotiate a deal with J&J and the COVAX facility to send vaccines directly to humanitarian settings and conflict zones to vaccinate displaced people.


  • Expanding mRNA vaccine manufacturing capacity by an additional 1 billion doses per year, with production starting by the second half of 2022. Note that this refers to the  BARDA RFI released last month.



  • Ensure We Are Prepared for All Scenarios 


While no specifics are given, the administration noted that while we expect the current vaccines to be protective against Omicron, it is working with the vaccine manufacturers, FDA, and CDC to develop contingency plans and will support new vaccine development and authorization if needed.   

What it Means

Coverage of OTC tests

Other countries have embraced and deployed rapid testing for COVID-19 much more rapidly than the US. There are various reasons for that, but the messaging on the importance of testing and the value of at home tests has started to shift this fall due to the rise in breakthrough cases and sustained danger to older Americans. The move to eliminate the cost of an at home test (about $20-25 for a two pack) is a big step towards improving folks’ willingness to use them.

However, there are going to be a lot of questions hanging out there until January 15th with the tri-agency guidance is released. First – if anyone has ever tried to get reimbursed by a health plan you know it can be, well, interesting. A product that is “free” is logistically different than a product you need to pay for out-of-pocket and then figure out how to submit paperwork to get the money back. To that end, your author expects that the guidance will have some rules of the road for the process health plans use for reimbursement. 

Second, we do not expect the guidance on workplace screening to change – meaning that insurers still do not have to pay for “screening” tests required by an employer. How those can actually be delineated from tests a person wants to use to diagnose themselves is an outstanding question. It’s also an outstanding question about whether there will be a limit on how many tests will be covered and if there will be efforts to prevent hoarding or resale on the grey market. 



WH Fact Sheet

CMS Press Release