Are OTC Medications Reimbursable?

In 2010, Congress passed the Patient Protection and Affordable Care Act (“PPACA”). The law requires a prescription for FSA reimbursement of over-the-counter medications and drugs (including Tylenol, Advil, Claritin, and cough medicines). The change took effect on January 1, 2011 for all plans, regardless of plan year basis.

While we as participants certainly enjoyed having over-the-counter drugs reimbursable through our Health FSAs prior to 2011, the statistics have shown that over-the-counter drugs represented a very small percentage of reimbursements. Thus, even with the change, the Health FSA remains a significant and effective tool for employees to save valuable tax dollars on their out-of-pocket medical expenses.

Note: The rule does not affect non-drug over-the-counter items or insulin, all of which are still fully reimbursable without a prescription. The non-drug over-the-counter items still reimbursable without a prescription include bandages, contact lenses, diagnostic devices, and many others.

Common Questions

Q. How do I submit my over-the-counter medicines or drugs with a prescription so that I can get reimbursed from my Health FSA?

A. You should submit a claim on the participant portal or mobile app with (1) a copy of the prescription and (2) a receipt or valid documentation for the over-the-counter item(s) purchased.

Q. If my plan offers a debit card, can I still use the ProBenefits Visa Debit Card to purchase over-the-counter drugs?

A. No. In 2011, health FSA debit cards and related systems were reprogrammed so that the card can no longer be used to purchase over-the-counter medicines or drugs. The ProBenefits Debit Card remains available for use at qualified merchants for other eligible items (including non-drug over-the-counter items).

Q. How does this change affect over-the-counter medical devices and supplies?

A. As noted above, the rule does not apply to items for medical care that are not medicines or drugs. Thus, medical items, supplies, and equipment that are available over-the-counter and are not drugs continue to qualify for reimbursement without a prescription. These items include, but are not limited to, crutches, bandages, contact lens, diagnostic devices, and many others.

Q. I currently use my Health FSA for reimbursement of co-pays, deductibles, prescription drugs, and dental and vision expenses. Am I still able to be reimbursed for those expenses from my Health FSA now?

A. Absolutely. The change to over-the-counter drugs is the only change that affected Health FSAs on January 1, 2011. All other eligible Health FSA expenses continue to be fully reimbursable. There was no change affecting prescription drugs, co-pays, deductibles, or dental or vision expenses.

 

Jason Cogdill is the lead in-house counsel for ProBenefits and oversees compliance initiatives for the organization. Jason, along with fellow attorney Laura Bibb (Senior Compliance Counsel), manages compliance support for plans and services provided by ProBenefits and serves as a resource for employers and plan advisors. Jason is a well-known, frequent speaker and presenter on a range of benefits compliance topics.