On March 27, 2020, the CARES Act was signed into law, which among other things, no longer required OTC medicines and drugs to be prescribed by a physician in order to qualify for reimbursement under a health FSA as of January 1, 2020. Prior to this change, Insulin was the only exception to an ACA provision requiring such OTC medications and drugs to be prescribed in order to be considered eligible for reimbursement. The following categories of items will require a doctor’s prescription (if incurred before 2020):
OTC products that are not medicines or drugs are reimbursable without a doctor’s prescriptions. The following are some example of OTC products that are available without a doctor’s prescription:
The following products have both a medical purpose and a personal/cosmetic or general health purpose. To be considered for reimbursement, either a doctor’s prescription (if expense was incurred before 2020) or a Letter of Medical Necessity (LOMN) will be required:
These products are considered cosmetic or used primarily for personal or general health purposes. The following products are not eligible for reimbursement, even with a Letter of Medical Necessity from a physician:
Debit cards can be used for OTC purchases provided that a prescription is presented to a pharmacist. The pharmacist must dispense the item in accordance with all applicable laws, and an Rx number must be assigned (the debit card system does not work unless an Rx number is assigned). The pharmacist must retain certain records (the Rx number, the name of the purchaser or the name of the person for whom the prescription applies, and the date and amount of the purchase), and the records must be accessible by the employer’s plan or its agent. If paying for items with your own money, an itemized grocery/drug store or pharmacy receipt that includes the name of the specific OTC product that was purchased will be required accompanied by a doctor’s prescription or when applicable by a Letter of Medical Necessity such as for Dual Purpose OTC Products. The receipt must also have the location and the date purchased. The IRS does not allow a generic receipt with a copy of the packaging as acceptable documentation. If the receipt does not list the specific OTC product, we cannot reimburse the expense.
It is not intended that these guidelines contain all reimbursable OTC medical items.
BenefitHelp Solutions is introducing a new tool, Health Shopper, to make it easy for you to shop for HSA and FSA eligible products online so you never have to guess if your purchase is covered. You can access Health Shopper directly from your BenefitHelp Solutions online member portal or by using the following link: https://my-healthshopper.com/?id=10583
When you go to Health Shopper you can:
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