Antihistamines: FSA Eligibility

Antihistamines: requires a prescription to be eligible with a Flexible Spending Account (FSA)

Antihistamines are over-the-counter (OTC) medicines that are eligible for reimbursement with a prescription with a flexible spending account (FSA), health savings account (HSA) or a health reimbursement arrangement (HRA). Antihistamines reimbursement is not eligible with a limited care flexible spending account (LCFSA) or a dependent care flexible spending account (DCFSA).

What are antihistamines?

Antihistamines are over-the-counter (OTC) medicines that are used to block the body's production of histamine, which is produced during the body's inflammatory response to the presence of an allergen or another microbe that the body views as an invader. Antihistamines work by blocking the histamine receptors in each cell, so as histamine travels throughout the body, it cannot activate these receptors and affect the cell. Without the use of antihistamines, common allergic symptoms like swelling, itching, nasal and lung congestion and others will continue as long as allergens are present.

The primary purpose of antihistamines is to fight the effects of histamine in the body, but variants of these drugs can differ in terms of their overall side effects. Antihistamines are available in numerous forms, including pills, creams, lotions, nasal sprays and eye drops. There are two primary groups of antihistamines: the older, first-generation products that feature ingredients like diphenhyramine or chlorphenamine typically causes drowsiness, while second and third generation antihistamines that feature ingredients like loratadine and cetirizine have the same histamine-fighting effects but do not cause drowsiness (Mayo Clinic).

What conditions do antihistamines treat?

Antihistamines are primarily used to combat the body's inflammatory response to allergens, and they play a major role in managing the symptoms of the following conditions:

  • Mild or moderate reactions to food allergies (severe reactions require medical attention)
  • Hay Fever/Allergic Rhinitis
  • Allergic Conjunctivitis
  • Allergic Skin Conditions (eczema, hives)
  • Insect Bites and Stings

Additionally, antihistamines have a wealth of other potential medical uses, as they have been known to treat stomach ulcers, motion sickness and insomnia (Patient).

Why does antihistamine reimbursement require a prescription from a doctor?

As a result of the passage of the Patient Protection and Affordable Care Act (PPACA), as of January 1, 2011, OTC items containing an active medical ingredient require a prescription for reimbursement with an FSA, HSA or HRA. To reimburse the cost of OTC medicines and drugs under FSAs, HSAs and other consumer spending accounts, account holders must submit a prescription for each product.

However, not every OTC product falls under this distinction and thousands of products continue to remain eligible without a prescription including bandages, first aid supplies, most sunscreens, diagnostic products, products for infant care and so much more. For more information on a specific product, be sure to consult our Eligibility List.

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Specifically Not Covered

Not eligible without a prescription.

Legal Information / Regulations

Prescription Required. Information Letter (IL) 2009-0209; Notice 2010-59.

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