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Arthritis Medicines: FSA Eligibility

Arthritis medicines are eligible for reimbursement with a prescription from a doctor with a flexible spending account (FSA), health savings account (HSA) or a health reimbursement arrangement (HRA). Arthritis medicines are not eligible for reimbursement with a limited care flexible spending account (LCFSA) or a dependent care flexible spending account (DCFSA).

What is arthritis?

Arthritis encompasses more than 1,000 types of joint pain and disorders that affect various areas of the body. Nearly 50 million American adults are affected by some form of arthritis and it is the leading cause of disability in the United States.

Arthritis symptoms can vary greatly from person to person, and some remain constant for years before becoming progressively worse over time. The most common symptoms associated with arthritis include various forms of chronic pain, including decreased range of motion, swelling, stiffness and pain when performing day-to-day activities. The most common forms of arthritis include:

  • Osteoarthritis: This form of arthritis is the most common form of the disease and typically affects the joints that bear weight, including the knees, hips, feet and spine. Osteoarthritis arises from the breakdown of cartilage that comes from the wear and tear of joints that eliminates the cushioning of the joint. This can result in chronic pain, inflammation and stiffness.
  • Rheumatoid Arthritis: As opposed to osteoarthritis that is caused by aging, rheumatoid arthritis is an autoimmune disease that attacks specific parts of the body, predominantly the joints. Inflammation is a hallmark of rheumatoid arthritis, as joint stiffness, as well as swelling in the hands, wrists, knees, neck, feet, ankles and other body parts, are symptoms that must be managed with the condition.
  • Psoriatic Arthritis: Some individuals who have psoriasis can develop psoriatic arthritis over time, even before the skin condition's symptoms appear. Psoriatic arthritis symptoms include joint pain, stiffness and swelling, and while these symptoms can affect nearly any part of the body, it is notable for its ability to afflict the fingertips and spine.

How do arthritis medicines work?

Although there is no cure for most types of arthritis, early detection of the condition and a strategy of pain management are key to controlling symptoms and living a normal life with the ailment. Arthritis medicines are a key facet of every treatment plan, but certain medications will only target specific symptoms. The most common arthritis medicines include:

  • Analgesics: This is the blanket term for a wide range of drugs that are used to bring about "analgesia," or pain relief. Unlike anesthetics that eliminate sensations, analgesics are designed to treat both peripheral and central nervous systems to alleviate pain associated with both mild and severe medical conditions.
  • Corticosteroids: These medications work by decreasing inflammation and the body's immune response by reducing the chemicals that cause inflammation and its associated symptoms. In particular, they are used for rheumatologic conditions like arthritis that result in pain and discomfort from the body's defense system working improperly. Examples of corticosteroid treatments include joint injections, skin creams, and ear/eye drops.
  • Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): This classification typically refers to drugs that manage mild to moderate pain involving the musculoskeletal system. In addition to pain relief, these drugs have anti-inflammatory and fever-reducing properties, which makes them ideal for alleviating pain relating to joint and muscle issues, headaches, arthritis symptoms, and everyday aches and pains. The most common over-the-counter (OTC) drugs include aspirin, ibuprofen, ketoprofen and naproxen, while more advanced NSAIDs can also be found in prescription form.
  • Biologics: Also known as biologic response modifiers, these medications are derived from a living organism, including viruses, genes or specific proteins and aim to replicate the body's normal response to infection. These are typically used for rheumatoid arthritis patients who may not have responded well to traditional treatment methods and need a medication that can target specific pain pathways, cells and proteins responsible for their symptoms.
  • Disease-Modifying Anti-Rheumatic Drugs (DMARDs): DMARDs are designed to slow the progression of joint damage arising from rheumatoid arthritis by manipulating the body's immune system response and preventing it from attacking joints and underlying tissues. DMARDs are typically used in conjunction with biologics, but may take weeks or months to slow or modify the disease process.

Why do arthritis medicines require a prescription for reimbursement?

As a result of the Patient Protection and Affordable Care Act (PPACA), as of January 1, 2011, new rules were put into place regarding the reimbursement of medical expenses. To reimburse the cost of OTC medicines and drugs under FSAs, HSAs and other consumer spending accounts, account holders must submit a prescription from a physician for each product.

Over-the-counter (OTC) arthritis medicines now require a prescription from a doctor to be purchased through an FSA, HSA or HRA. For more information on a specific product, please consult our Eligibility List.

 
Flexible Spending Account (FSA) Limited Care FSA Dependent Care FSA Health Savings Account (HSA) Health Reimbursement Account (HRA)
Eligible
Eligible with Rx
Eligible with LMN
Not Eligible
 
 
Additional Information

FSAstore.com's Prescription Process can help. Click Here to learn more.

Specifically Not Covered

Arthritis medicine without a prescription.

Legal Information / Regulations

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