Decongestant: FSA Eligibility

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

What is a decongestant?

Decongestants are OTC medicines that are designed to relieve nasal congestion and other symptoms associated with common colds, flu and allergies. Decongestants are often used in combination medicines like cough syrups, nose sprays, inhalers or pills, often used in tandem with antihistamines, pain relievers or sleep aids to help individuals manage their symptoms. However, decongestants are also extremely effective as stand-alone products that are highly effective in combating nasal congestion.

How do decongestants work?

The most common active ingredients in decongestants are pseudoephedrine (commonly used in Sudafed) and phenylephrine, and they combat nasal congestion by constricting the blood vessels in the nose, throat and sinuses, which in turn reduces inflammation in these areas and jumpstarts mucous formation. By removing this pressure and improving the flow of air in the nasal passageways, this can allow users to breathe more sufficiently and more easily liquidate mucous from the nose, chest and throat to limit the duration of cold, flu or allergy symptoms.

Why do decongestants 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-directed healthcare accounts, account holders must submit a prescription from a physician for each product.

Over-the-counter (OTC) medicines like decongestants now require a prescription from a doctor to be purchased through a 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

Additional Information

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

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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