Prescription now needed for over-the-counter reimbursement
11 February 2011
Due to the Patient Protection and Affordable Care Act of 2010, as of Jan. 1, 2011, patients who use flexible spending accounts (FSAs), health reimbursement accounts (HRAs) and other tax-supported health benefits will have greater restrictions on their reimbursable spending. Patients that purchase over-the-counter (OTC) medicines and drugs will be required to submit a written prescription from an authorized health care professional for these items to be eligible for reimbursement. These items include such over-the-counter medicines as antacids, cold and allergy medications, pain relievers, etc.
This change does not impact insulin, medications that legally require a prescription to be dispensed or OTC items that are not in the medicines or drug category (such as crutches, bandages, etc.).
Additionally, patients are not able to use debit cards that are issued in conjunction with FSAs or HRAs to pay for OTC medicines or drugs as of Jan. 1, 2011 because the system used to track the eligibility of purchases is not able to recognize which OTC medications have been prescribed and which have not. Program participants are now required to submit claims online, by fax or by mail for all prescribed OTC medicines and drugs.
The Internal Revenue Service has created an online document with several frequently asked questions (FAQs) and answers about the new rule. Physicians may decide to share these FAQs with their staff to assist with patients’ questions and requests for prescriptions for OTC medicines and drugs.
Practices are experiencing an uptick in patient requests for OTC written prescriptions as a result of this restriction. For more information on potential changes to your practice brought about by the Patient Protection and Affordable Care Act, click here
to see MSV's national health care reform knowledgebase.