Heather Shadley-Tovar shelled out $120 to get her daughter a PCR test.
Elisha Wright spent about $300 on her daughters' antigen tests.
And Libertad Wright-Villanueva "bit the bullet" and ponied up $346 for her son and husband's tests.
All are members of the San Diego Vaccine Hunters Facebook group. They were exposed to COVID over the holidays. At-home antigen test kits were sold out and free appointments were booked for weeks, but some needed to know if they had put their relatives at risk and others wanted to know if they were clear to celebrate the new year with relatives. So, they paid for testing.
"I decided that this was really the only option for us because when you need answers ... you need them in a timely manner, not a week from now," said Christine Izzo, another member of the Facebook group.
Even though the general rule is that insurance should cover the cost of testing and a limited number of at-home test kits, and free kits are available, supply is limited and people continue to turn to expensive options.
Izzo's son goes to college in Chicago and her daughter is in a nursing program in San Diego. They had not been exposed. But their schools, like many, required a negative test to come back after the holiday break.
Izzo can get tested through work – she's a nurse at Sharp Memorial in San Diego – but her kids cannot.
"So, midweek [between Christmas and New Year's Day], I began searching," she said.
Many of the local testing sites closed for the holidays, Izzo said, and her healthcare provider would only test people with symptoms. As for at-home antigen kits: "I called a number of pharmacies, grocery stores, they just were nowhere to be found."
Time was running out and her kids' winter break was almost over, so Izzo expanded her search to include anywhere that could deliver results before their deadline. She found just one, and she'd have to pay.
"The rapid test for my son was $125, paid out of pocket in advance. And my daughter's PCR test with a report was $299. I swallowed hard," Izzo said. All up, it was $434.
She made an appointment at 2:00 p.m. for New Year's Eve.
"The line was extraordinary," Izzo said.
She estimates 200 cars snaked around the mall parking lot where the drive-through clinic had set up, about 20 miles from her home.
"It was an extraordinary volume of people. My thought was, I cannot believe the amount of people paying this amount of money for a simple COVID test that you should be able to purchase in your local pharmacy, and [tests] that are supposed to be available free of charge."
Two hours after their appointment time, Izzo's son and daughter rolled down the car windows to be swabbed. Izzo estimates they received their results about five hours later – both negative.
"I am blessed to say that for us, I'm able to work a couple of extra hours and cover the cost without a significant financial hardship," Izzo said. "I recognize for other people that means they wouldn't eat for a few weeks and that so many people just couldn't bear the cost." Izzo says her insurance rejected her reimbursement request.
The rise of boutique test sites
As omicron has muscled out delta to become the dominant COVID strain, hours-long lines have become common at free testing sites across the country. Many people haven't been lucky enough to snag an appointment. And at-home antigen tests have been just as scarce, in some areas. Boutique testing sites have sprung up to meet the overwhelming demand.
Since just before Christmas, about 200 people a day have pulled into the reserved parking places in front of Pure Care Pharmacy, in a small strip mall sandwiched between tract homes, about 20 miles north of downtown San Diego.
They come seeking COVID tests – willing to pay between $85 and $240 for them – many after failing to book free tests with the omicron crush.
"It's definitely helped us out financially," says Mina Said, who opened the independent pharmacy with his wife in 2018. They aim to be a family pharmacy, Said said, "to take care of the patient, not the prescription."
Pure Care began offering COVID tests in May, 2020.
"It's something that we've always had even before the pandemic, to provide these types of services – whether it's lipid panel, glucose testing or blood pressure testing – to the community," Said said. "This just fit into that same role, so it was a no-brainer for us."
Said said he was already licensed to perform simple laboratory tests. All facilities that provide COVID tests must be authorized under federal and state law. He said his big gamble when the pandemic began was whether to invest about $5,000 in antigen tests. He says back then, he had to buy in bulk – the smallest quantity he could purchase was 300 tests.
"It was a pretty big investment when a lot was unknown. You don't know if people are going to adopt this, or if it is going to take off," he said. "Back then, when we started antigens, maybe we'd get one to two people testing a day. But, it's paid off since."
Said said these days, each antigen test costs his business between $6 and $40, depending on the brand, and supply and demand. In turn, he charges $85.
People swab themselves in their cars and pass the specimen to Pure Care employees out the window to be read inside the pharmacy. Said said it's basically the same as an over-the-counter, at-home test. Results come back in about an hour, though the surge in demand has extended the wait, lately.
Meanwhile, for PCR tests, Said said his business pays pharmaceutical companies between $100 to $150 each.
"You can sometimes find a good deal where, if you buy many, they'll give you a discount," he said.
He charges his customers $240. PCR tests require a reader — a piece of equipment that cost about $900 early in the pandemic, according to Said's estimate, but has since come down to about $500. Said said he had bought many because each machine reads only one test at a time, though many larger labs have more expensive equipment that can process multiple tests simultaneously.
Said was reticent to talk about how much profit his pharmacy is making off COVID tests.
"The way we look at it is part of the profit ... is that we provide a service. We're providing the actual test itself, but we're also providing education. When we call with people's results, say you have a positive result, we're going to guide you through that. We consider that as part of the cost because it takes our time and expertise," Said said.
He added that they determined their prices for COVID tests by what the market would bear. "We wanted to stay competitive but, at the same time, stay with what the market value was," he said.
Said says because he's an independent pharmacy he cannot contract with health insurance providers on medical tests.
More free tests are a start
A bit further east, another laboratory charges $120 for a rapid PCR test, but reviewers complain that long lines back up into traffic. One national testing service makes house calls for $499. And Amazon offers its own brand of PCR test — processed by a laboratory it built — for $39.99. Though, they're currently unavailable.
Donaldson Conserve, an associate professor in the Department of Prevention and Community Health at the George Washington University, says paying out-of-pocket for tests is a stopgap for those who can afford them.
"Unfortunately, the high cost prevents individuals who don't have the finances. But, even for those who can, it's not a sustainable approach. You may test negative today but get exposed next week. No-one wants to pay $400 every other week," Conserve said.
Insurance reimbursement for people who pay for tests varies depending on the circumstances of the test and people's plans.
Conserve likes the Biden administration's plan to provide free at-home test kits, though he says it comes a bit late. "Unfortunately, the focus was on promoting vaccination, thinking that would be enough. It's not," Conserve lamented.
President Biden announced Thursday that his administration will buy another 500 million at-home COVID tests for Americans on top of the 500 million he announced they had purchased last month.
"We're on track to roll out a website next week where you can order free tests shipped to your home," President Biden said Thursday, during a COVID response update. "And for those who want an immediate test, we continue to add FEMA testing sites, so there are more free in-person testing sites."
Starting January 15, insurance companies will have to reimburse people for eight at-home COVID tests a month. Families can order four free at-home test kits through the website COVIDtests.gov beginning January 19, according to senior administration officials. However, they said last week that the tests will take 7 to 12 days to arrive, which means people won't receive them until the end of the month, at the earliest.
Conserve said in order to be effective, distribution efforts must continue beyond a few months. "It has to be normalized and people have to get used to testing at home and understand where to get the kits and how to order them online," he said.
He'd also like to see more self-testing campaigns, in tandem with churches, barber shops and other pillars of trust.
"We have communities that are not aware of free self-testing ... communities that are most affected by the high rate of transmission," Conserve said. "And one of the reasons I believe is because some of these distribution strategies are only online. They don't have community partners going around to raise awareness and distribute kits."
Meanwhile, Christine Izzo, who paid more than $400 for her son and daughter to be tested, said the moment they got home from getting swabbed, she sat back down at her computer to book three more rapid PCR tests — one a week — required by her daughter's nursing program.
Good fortune got her an appointment at a free county site that promised a 48-hour turnaround. When Izzo spoke with NPR three days later, she was still awaiting the result.
A previous version of this story included NPR's estimate of Pure Care Pharmacy's revenue from Covid testing. We could not confirm this figure so we have removed it.