Update: As of March 2020 with the passage of the CARES Act, the OTC Rx requirement has been repealed and prescriptions are no longer necessary to purchase over-the-counter medicines with an FSA or HSA. Additionally, menstrual care products like tampons and pads are fully FSA-/HSA-eligible. Learn more here.
Since open enrollment is well underway, and we're speaking to a growing group of new FSA owners, it's only right that we revisit one of our most-common questions -- why do we need a prescription to buy over-the-counter (OTC) meds with our FSA cards?
If you've wondered about this, we definitely understand your confusion. Obviously, if you wanted to purchase OTC products like ibuprofen or cold medicine with a standard form of payment, you wouldn't need a script for them. So why would you need to prove a medical need to use tax-free funds? Let's get one thing out of the way, it's a requirement imposed by the Patient Protection and Affordable Care Act (PPACA) and enforced by the IRS.
A quick history lesson
The answer dates back to January 1, 2011 -- a veritable lifetime in consumer healthcare years -- when the government passed PPACA. This law established a new uniform standard for medical expenses, meaning OTC products containing an active medical ingredient of any kind would require a prescription from a doctor.
But the government isn't doing this to make things more difficult, or even to discourage use of tax-free funds. Instead, the initial thinking was that this OTC provision would help raise revenue to expand coverage for uninsured Americans.
So, long story short, if you want to buy these products without having to pay taxes on them, you'll need to verify a qualified medical need for doing so. This includes the items mentioned above, alongside any other pain relievers, cold and allergy remedies, and even cough drops.
Some OTC favorites
Xyzal Allergy 24 HR Tablets, 55 ct
Aquaphor Healing Ointment Jar, 14 oz
It's not like the OTC rule applies to everything on our site - just things that contain an active medicinal ingredient. So, medical supplies like crutches, bandages and even diagnostic devices still qualify for FSA reimbursement without any other documentation. In fact, of the 4,000+ eligible items in our store, only a small percentage requires a prescription, so shop with confidence!
And to add to that confidence and create less confusion, we even make it easy for you to decipher which products require a prescription and which do not, with a simple check mark symbol for no prescription required and an Rx symbol for when it is.
Are there changes coming?
There's always hope, but we don't like to think of the OTC provision as "something to work around.". Does it make things slightly more complicated for FSA users? Maybe… but we have our own answer for this -- the Prescription Process.
By using this simple tool, if you purchase eligible OTC medicines at FSAstore.com, you just need to click on the prescription banner to get started. Then, you simply need to provide a physician's name, address and phone number, and our pharmacy partner will reach out directly for the required docs to help you obtain the prescription to complete the purchase. No other work is required.
So, reform might be underway in Washington, but at least you know you have a way to buy these products tax-free, with minimal fuss. Once you start seeing the savings, we think you'll realize it's about as effortless as can be.
From FSA basics to the most specific account details, in our weekly Asked and Answered column, our team gets to the bottom of your most-pressing flex spending questions. It appears every Wednesday, exclusively on the FSAstore.com Learning Center. And for the latest info about your health and financial wellness, be sure to follow us on Facebook, Instagram and Twitter.
If you have any prescription medications you take on a regular basis, you probably have a routine - go to the pharmacy, wait in line, hand over your insurance card and pay for the prescription with your debit or credit card.
Even with your insurance chipping in, chances are you end up paying a decent chunk of the bill out-of-pocket. If you're battling a chronic condition, those costs can really add up over time. But what if you could get that medicine at a cheaper price without using your insurance card?
It might sound crazy, but billing your insurance isn't always the most cost-effective option. Here's what you should know about the alternatives, and how your FSA card can save you even more.
Pay for prescription medicine instead of using insurance
A recent investigative report from The New York Times and ProPublica found that 40 common prescriptions were cheaper using GoodRx, a prescription discount card, than billing insurance.
GoodRx is the most common type of prescription discount card, and it's completely free. Blink Health, SingleCare and WellRx are some of the other cards available. All you have to do is print one out or have it mailed to you.
These discount cards only apply if you don't bill the prescription to your insurance. Here's how it works: You fill the prescription at a pharmacy, present the GoodRx or similar discount card and then pay for the remainder with your FSA card. Some pharmacies will even have the cards sitting out for anyone to use.
Discount prescription services list their prices before you buy, so you can see if it will be cheaper than using insurance and which pharmacy has the best price. As with most cost-saving measures, shopping around is a step toward saving the most money.
Pay for over-the-counter medicine
You can use your FSA card to pay for over-the-counter (OTC) medicine if a qualified professional has prescribed it (note that OTC items which do not contain an active medical ingredient will not require a prescription and you can shop for thousands of qualified items here). The prescription must be written before you buy the drug and generally within the FSA plan year in which you purchase it. .
You can use your FSA card when you buy the item at the drugstore. You can also pay with a regular debit or credit card and then request reimbursement from your FSA provider. Keep the receipt and the prescription to prove it's a qualified medical expense.
Pay for prescription medicine after insurance
If billing your insurance is still the cheapest way to buy a prescription, you can use your FSA card to save even more money.
When you fill the prescription, give the pharmacist your insurance card. They'll run the prescription and bill you for any leftover amount. You can pay for that directly with your FSA card or use a debit or credit card and then file a claim with your FSA provider. And of course, keep the receipt to prove it was an FSA-eligible expense.
Eligible with Rx
Relieve seasonal and year round allergies.
Get you back on track, all day long.
New to FSAs? Need a refresher course in all things flex spending? Our weekly Flex-Ed column gives you a weekly dose of FSA Living 101, offering tips for making the most of your tax-free funds. Look for it every Thursday, exclusively on the FSAstore.com Learning Center.