eNewsFlash: Health Care Reform Update on Over The Counter Medicines

The Patient Protection and Affordable Care Act—also known as health care reform —was signed into law on March 23, 2010 and brings with it some changes in the way over-the-counter (OTC) medications and other non-prescription items will be reimbursed through flexible spending accounts, health savings accounts and health reimbursement arrangements.

Starting January 1st, 2011, all OTC items eligible for reimbursement must be accompanied by a doctor’s prescription and a reimbursement request (claim form). They may no longer be purchased using the eflex card.

Below are answers to some common concerns regarding this new legislation.

Will I still be able to use my eflex card to get reimbursed for my regular prescription medications?

Yes, prescription drug reimbursement will not be affected by this change, and you will still be able to purchase prescriptions with your eflex card.

When does this change go into effect?

This change will go into effect January 1, 2011 and will apply to the taxable year, as opposed to the plan year. Therefore, all plans and participants will experience the change at the same time.

What if my plan year runs from June 1, 2010 through May 31, 2011. Can I get reimbursed for OTC items through the end of my plan year?

No. Eligibility for OTC items ends on December 31, 2010 regardless of plan end date. However, you may still use remaining funds for all other eligible expenses until the end of your plan year.

If I do get a doctor’s prescription for an OTC, can I still use my eflex card to get reimbursed?

No. The eflex card may no longer be used as payment for any OTC items. However, you may use another form of payment then submit a reimbursement request along with the doctor’s prescription. Rest assured, eflex offers the fastest reimbursement service in the industry and will usually process your claim in less than two business days of receipt.

I am a diabetic. Will I need a doctor’s prescription to get reimbursed for my insulin after December 31, 2010?

No. Insulin that is currently purchased over- the-counter without a prescription will still be eligible for reimbursement. However, the eflex card will no longer be accepted as payment after December 31, 2010, and a manual claim form will be required for reimbursement.

What if I purchase an OTC item in November of 2010 but do not submit the expense until February 2011?

You will still be reimbursed for OTC items purchased prior to January 1, 2011. The new rule does not affect reimbursement of any purchases made prior to that time.

What are some of the OTC items that will no longer be eligible for reimbursement without a doctor’s prescription under the new legislation?

The items no longer eligible for reimbursement under the new law will include item categories such as cough medicines, pain relievers, acid controllers, and allergy & sinus medications, to name a few. A complete list of items being affected by this change has not been made available by the IIAS*, but according to sources at the National Association of Professional Benefit Administrators (NAPBA), a preliminary list of categories that will no longer be eligible for reimbursement include:

Acid Controllers Allergy & Sinus

Antibiotic Products Anti-Diarrheal

Anti-Gas Anti-Itch & Insect Bite

Anti-parasitic Treatments Bandages

Baby Rash Ointments/Creams Cold Sore Remedies

Cough, Cold & Flu Digestive Aids

Feminine Anti-Fungal/Anti-Itch Hemorrhoid Preps

Laxatives Motion Sickness

Pain Relief Respiratory Treatments

Sleep Aids & Sedatives Stomach Remedies

This legislation will not affect other reimbursement benefits such as expenses related to doctor’s office co-pays, dental co-pays, orthodontia, vision exams, eye glasses, and more. Participants will continue to enjoy the convenience of eliminating up-front, out-of-pocket costs on many other items covered under their plans.

We appreciate the opportunity to serve as your TPA administrator and are committed to keeping you informed of any legislative changes that might affect flex plans.

If you have any additional questions or are unclear how this new law will affect your plan, please do not hesitate to contact your eflex administrator or sales@eflexgroup.com.

*IIAS is a point-of-sale technology and inventory system approved by the IRS to track the eligibility of purchases made by debit cards that are issued in conjunction with Flex Spending Accounts (FSAs), Health Savings Accounts (HSAs) and Health Reimbursement Accounts (HRAs).