New Rules for OTC Purchases

Charleston, SC(Zone 9a)

Apparently, OTC meds will now only be reimbursed for Flex-Spending Accounts if accompanied by a PRESCRIPTION. That's right. You will need to see your Dr and get a prescription for aspirin, tylenol, and other such OTC products if you want to be reimbursed for them on your flex spending program. I'm not sure if all states have implemented this yet, but it apparently applies to all and has been implemented already in some areas.

Drs are going crazy. They obviously don't have time to write a handful of prescripts for everything we buy OTC. Plus they have concerns regarding lawsuits for every OTC product that harms someone for whom they've written a script. Some are refusing to write such scripts. Others have instituted a fee of $5 or even $10 per OTC script - which would seem to negate any savings from Flex Spending on these items.

It's a problem for pharmacists as well. Normally, they only dispense prescript items which are behind the counter. Not sure how they will handle this - not to mention the time issue as most are already swamped with 'real' scripts.

As for us, well, I don't have the time (off from work) to run to the Dr for scripts for all the things I use. I will probably just stop including OTC items in my Flex Spending reimbursements once this comes to my area, if it hasn't already.

Just wondering if others have been made aware of this yet and/or it has already been implemented in your area? Also wondering how you are handling this and how it's working out for you (if it is already in place in your area).

Milton, MA(Zone 6a)

It's a PAIN IN THE BUTT! My docs are used to me (I'm pretty high-maintenance all by myself and both my kids are heavy prescription users too). I have the MDs write scrips for "baby wipes" and "surgical gloves" "dressing supplies" "blah blah blah". It took a while to explain the concept, but once that got through it wasn't so bad. OTOH, my docs have an email system and office staff who do all the clerical parts--I can write a note and they can read it, or even somebody ELSE reads and summarizes. The only problem I have encountered has been stool softeners! My Medicare Part D co-pay is maybe $10 for a bottle of 90 if she writes a prescription. If I bought them OTC and submitted it would be $20 for 200? Less? But FSA wouldn't reimburse unless I get her to write ANOTHER prescription and send it to me instead of to the pharmacy. She would do that if I could explain why.

Then again, in 2011 I was carefully saving every receipt. 2012 my dingbat husband DIDN'T re-up the FSA because he saw me working so hard and the money leaving his check. Duuuh. In 2012 we had a Change of Circumstance (my daughter and I got added to his BC/BS) which gave us a chance to restart a new FSA acct. Here's my question: may I submit the hundreds of dollars of legit actual prescription stuff I had to pay out-of-pocket in between the two FSAs? What do you think? It is Rxs that weren't covered by any insurance. For the kids.

Stamford, CT(Zone 6b)

Depends on the terms of your flexible spending account, but probably not unless there is an overlap. You have an unusual situation with your daughter, and you may have to ask for a supervisory review.

Milton, MA(Zone 6a)

Sounds like a lot of fun, fun, fun!

Newark, OH(Zone 5b)

I deal with this junk, too. Something like Diphenhydramine Hydrochloride (Benadryl) I can get for $2 or $3 OTC, but if I get it via Rx it's a $20 copay. I have to get pseudoephedrine (Sudafed), too, so it's the same deal. Insane. :( It's only going to get worse, too. The pharmacist said I *might* be able to get reimbursed for them if I send an Rx in to my flex benefits card services along with a receipt. She said some customers have seen that.

Milton, MA(Zone 6a)

I just went to the pharmacy today for other Rxs--she was going to refill my (non-rx) colace that my MD wrote a scrip for. I'm pretty sure I can get the (much cheaper) OTC stuff reimbursed, but I have to show them I have a scrip dated before I bought it. My doctor didn't get it, so now I'm stuck either paying the co-pay for non-prescription stuff (steeper, cause they wish you would buy it yourself) or getting a new scrip. I wonder if Walgreens can make me a copy of the prescription for FSA? Definitely a headache.

Yeah, the trick is to get the Rx from your MD *before* you spend the cash. Should work, but it's h3ll keeping track of all the receipts!!

Stamford, CT(Zone 6b)

If you need to get a reimbursement for aspirin, acetominophen, colace, you are losing the purpose of a flex spending account. If you don't need prescription meds filled, you should be very thankful and stop complaining.

A good pharmacist will always tell you when a drug on a prescription is sold over the counter. You have to be your own advocate when it comes to figuring out when it is not worth a co-pay. Most plans charge very little if you are getting a generic drug rather than a brand. I would be thrilled if our meds were sold over the counter. You cannot imagine what Ranexa costs. It is not Sudafed.

Milton, MA(Zone 6a)

I'm talking about $100s in OTC meds each month in addition to the expensive prescription drugs I take. My husband is on 3 blood pressure meds, for instance. The one that's available as a generic is not expensive, but the other two are. My daughter's severe asthma gets treated with the latest three asthma drugs, one of which is generic, another costs $200 month. I won't even bore you with the list of ten meds (Rx) I take a day and the prescribed OTC things. I mean where my doctor says "you need to take colace 3 times a day for the rest of your life." That's a lot of colace. You'd better believe I'm going to take advantage of every chance to get those expenses down, and if having a prescription for stool softener and ibuprofen saves me $16-32 a month, then I'll be saving around $360 a year, almost one free month of prescriptions.

Sorry if you think we're petty; we're just trying to figure out how the rules work so we can take advantage of our FSA accounts. We wouldn't even have FSA accounts if we didn't have substantial OOP health care expenses. It would be crazy to risk money with the use-it-or-lose-it FSA system if you didn't feel you had substantial expenses, and then once you've risked that money, it's up to you to use it up. Better on aspirin than have it revert to the government, surely.

Stamford, CT(Zone 6b)

If you have money left from your FSA, you can always get another pair of glasses or something similar. Never let it go unspent.

Milton, MA(Zone 6a)

I'm with you there!

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