Health Care Reform and Over-the-Counter Medications

Beginning January 1, 2011, the Patient Protection and Care Act (PPCA), aka Health Care Reform law, requires that over-the-counter medications (other than insulin) must be prescribed in order to qualify for reimbursement under your flexible spending account (FSA) or health savings account (HSA). This change will have dramatic impact on the way we purchase and use over-the-counter items. Some are suggesting that health care costs will increase as individuals schedule physician office visits to get prescriptions for these items, while others suggest that drug costs will increase as some opt for the more expensive “prescription-only” medications to ensure coverage is provided under their health plan.
At a minimum, this change will cause a great deal of confusion for all of us and has the potential to overwhelm pharmacists as participants flock to have their over-the-counter prescriptions filled by the end of the year. Those of us with FSA or HSA debit cards may have issues with the processing of these claims after January 1st.
Confused yet? At this point, the Department of Health and Human Services has not issued clarification regarding what is defined as a “medicine or drug.” At present, the IRS circular includes items that are “generally accepted as falling within the category of medicine or drugs”.

If you have questions about your health benefits, or would like someone to talk to about these or other issues, please call my office during normal business hours.

Doug Roehm
Strategic Benefit Services
139 Walnut Blvd
Rochester, MI 48307
800-727-4114