Cough Syrup: FSA Eligibility

Cough syrup is an eligible over-the-counter (OTC) item with a prescription from a doctor with a flexible spending account (FSA), health savings account (HSA) or a health reimbursement arrangement (HRA). Cough syrup reimbursement is not eligible with a limited care flexible spending account (LCFSA) or a dependent care flexible spending account (DCFSA).

How does cough syrup work?

Cough syrups fall into a family of cold and flu medicines that combine myriad active ingredients to treat symptoms that are associated with the common cold, flu and bronchitis. These medicines are formulated to treat both children and adults, and are available in a variety of flavors, strengths, drowsy/non-drowsy formulas to provide relief for a wide variety of potential symptoms. While some products may be available in single ingredient variants, most often they are packaged as "combination medicines" with multiple active ingredients to treat various symptoms at once.

The active ingredients found in OTC cough syrups will play a major role in their efficacy and the symptoms that they treat. The following active ingredients are the most commonly used in OTC cough syrups that consumers should know to purchase the products most appropriate for their symptoms.

  • Cough Suppressants: Also known as antitussives, these substances are designed to inhibit the coughing reflex in the body to help reduce pain and aid the sleep cycle. A few common cough suppressants to look for include dextromethorphan and pholcodine.
  • Expectorants: These medicines are especially helpful in the event of a common cold or other condition that causes a major build-up of mucous in the nose and threat. Expectorants like guaifenesin or potassium iodide will thin mucous in these nasal passageways to make it easier to expel and eventually clear up nasal/chest congestion.
  • Decongestants: These substances are designed to reduce swelling and other inflammation in the nasal passageways to improve the flow of air and breathing overall. The most common ingredients to look for are pseudophedrine or phenylephrine.
  • Antihistamines: These medications are extremely effective in controlling allergy symptoms brought on by the body's production of histamine. When the body comes into contact with an allergen, histamine is released in the blood that attaches to cells and causes symptoms of itching, sneezing and watery eyes. Antihistamines block these histamine receptors to dramatically reduce the outbreak of allergic symptoms, which include doxylmaline, brompheniramine, diphenhydramine and more.
  • Analgesics (Pain Relievers): Acetaminophen and aspirin in small amounts are the most common analgesic agents added to OTC cough syrups. These ingredients will assist in alleviating the aches and pains associated with cold and flu symptoms.

Why does cough syrup require a prescription for reimbursement?

As a result of the passage of the Patient Protection and Affordable Care Act (PPACA), as of January 1, 2011, a new set of uniform standards 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) medicines like cough syrup now requires 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.

Eligibility Table

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

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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