Flexing Scripts Over The Counter

Rules have changed when it comes to insurance flex account coverage on Over The Counter medications.

The new health care reform law requires a doctor's prescription for any OTC medicines that someone might want their flex spending account to pay for. Insulin is exempt and anything else you might normally have an Rx for isn't affected, just those on the shelf items such as cold medicine and aspirin. The IRS says this applies only to "medicine" or "drugs," and not those supplies such as band-aids, crutches, contact lens solution, or blood glucose test strips and kits.

For me and many People With Diabetes, this specifically comes down to glucose tablets that are sold in the pharmacy aisles or endcaps. Since these are basically something you eat and can be dubbed a consumable "medicine" or "drug," the new Flex rule applies.

To be clear: The new rules don't limit these over the counters and don't stop a person from paying for these by cash or credit. Just not flex, unless you can basically prove it's necessary for your insurance company to pay via flex account. In a time of high health care costs and people use their insurance to pay for things such as aspirin and cold medicine, this new move is a necessary inconvienence.

I get it, but don't have to like it.

Now, there's nothing stopping me from going into my local pharmacy store and just using my non-insurance payment methods to get needed glucose tablets. At $4.50 per jar, one or two spread out every couple months isn't going to break the bank. But this is a needed item to help treat my diabetic Lows, which often seem to happen at the most inconvienent times and require some quick fixes. They're the most handy, and it's just logical to me that if my insurance does cover these, then I should make use of that.

My Endo likely won't have much of an issue in writing a script for these. However, I've learned from our insurance company's Flex Benefit people that we no longer are able to use the Flex debit card for any OTCs, prescription or not. Apparently the fed govt says that after Jan. 15, these flex debit and credit cards can no longer be used. Rather than putting that burden on the pharmacists to determine whether an OTC is Rx covered, the law change just don't allow this card use any more. So, we can pay there and then - if we've got an Rx -- request reimbursement at a later time.

Again, I get it and understand the reasons but just don't like the inconvienence of it.

This makes people think twice about using their Flex Accounts for these OTC items that may not actually be needed. It does a needed service, because many people do abuse these Flex Accounts and have sums leftover at year ends and go on OTC spending binges to use up those amounts. So, maybe now the Flex Account use will be a little more realistic. If people really need something, say like glucose tablets, then they can just pay another way and get reimbursed later if they go through the prescription-obtaining process.

Anticipating this change that took effect Jan. 1, we went out on New Year's Eve and stocked up on glucose tablets. All that was on the pharmacy endcap were 4 plastic jars, so that's what we bought. Along with the Rx items that were due for refills, it was productive visit that was convienently all compiled onto the same receipt for easier record-keeping later on.

Now, that has all changed.

This Employee Benefits Legal Blog offers a recap of the changes, and this IRS Q&A offers some good information for inquiring minds.

But this can all be avoided entirely.

All one must do is go for Smarties instead of glucose tabs. You know, the bite sized versions of the flavored sugar tabs that are better tasting, cost less money, and avoids the health care hassles of insurance companies, prescriptions and pharmacies.

To avoid having to Flex Prescriptions over those Over The Counters, then this may just be the way to go!


Anonymous said…
And don't forget, on your first visit to your doctor, bring a list of all your OTC medications and request an Rx good for the year as needed. In my case, I spend out my spending account well before I even get to the tylenol, but others may need to worry. In either case, also remember that even worse times are on the way as in 2013 the limit for flexible spending accounts drops to only $2500.
Anonymous said…
To avoid having to Flex Prescriptions over those Over The Counters, then this may just be the way to go!

True , :)
Pete said…
There so needs to be a diabetic/chronic sort of exemption. I put $4,000 in my FSA last year and I exhausted it by November at the latest. We got health insurance reform, nothing more. And even that is toothless and insufficient. I was very disappointed in the "health care" reform. Health insurance for profit is a ridiculous idea. How did it catch on? It's absolutely insane. I figure that I support this economy plenty with my care and feeding. I'm trying to keep myself as healthy as possible (a) because I hate to be uncomfortable and (b) I don't want to be expensive when I'm on Medicare.. As a tax payer myself, I'm doing my best to take it easy on my fellow Medicare tax payers. I think it's my patriotic duty -- and I'm only 3/4 kidding.
Jacquie said…
Gummy frogs forever!

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