OTC Medications: New Regulations for Flexible Funds Reimbursement.

There is going to be a change with flexible funds reimbursements including HSA cards.  As of January 1, 2011, prescriptions are needed for all over the counter medications.  This means in order to get reimbursed your doctor will have to send an escript or write one.  If the doctor sends an escript, make sure it says “OTC”.  You don’t want to have to fill it through the pharmacy especially if it is less expensive at places like Costco.  Prescriptions filled through the pharmacy,  will have a copay and may be cheaper but not all.

The new regulation states you can send a copy of the prescription with the receipt or the receipt if from a pharmacy has printed prescription on it.  I noticed that some pharmacies like CVS are no longer accepting HSA cards.  I am not sure if this new regulation is tied into the change.  HSA cards were used by many people to purchase OTC medications.  It will be difficult to verify written prescriptions and use the HSA.

A common OTC medication group is anti-acids/reflux dugs like Zantac, Prilosec and others.  These drugs will now need a prescription for reimbursement.  Medications like Aspirin, Tylenol and Advil fall under this category.

Diabetic supplies are exempt from this rule and some medical equipment.  Gauze,salve, betadine and tape is not exempt.

I have not been able to get a clear answer as to why this regulation has been imposed.  I would hope it is because there has been abuse with flex/HSA funds for OTC medications and other items.

The burden is now on the consumer to get the prescription from the provider.  I predict many after appointment calls to medical assistants asking for forgotten prescriptions.  I hope programmers upgrade electronic records to reflect the need.