Patient Protection and Affordable Care Act

In January 2011, as a result of the IRS 2010-59 and 2011-05 rulings, a prescription will be required for OTC drugs and medicines (other than insulin) in order to qualify as "medical care" for the purposes of employer sponsored health plans including Health Flexible Spending Accounts (FSAs), Health Reimbursement Accounts (HRAs) and Health Savings Accounts (HSAs). Many categories will remain eligible without a prescription including items such as band aids, reading glasses, hearing aid batteries and many more. In addition, the IRS notices provide guidelines for the reimbursement of "OTC Drugs and Medicines" where a prescription has been written and the product has been dispensed as a prescription.

The following provides a summary of helpful information regarding the impact of the Patient Protection and Affordable Care Act (PPACA) on health benefit accounts.

  • The IRS 2010-59 ruling that goes into effect in January 2011 makes a prescription required for OTC medicines and drugs (other than insulin) in order to qualify as "medical care" for the purposes of employer sponsored health plans (including Health FSAs and HRAs) and Health Savings Accounts.

Categories no longer eligible without a prescription are as follows:

To purchase these items with their health benefit account, the consumer should get a prescription from their doctor then have the pharmacy dispense the product as a prescription including the generation of a prescription number.

  • Acid Controllers
  • Antibiotics
  • Anti-Gas Products
  • Anti-Parasitic Treatments
  • Cold Sore Remedies
  • Digestive Aids
  • Hemorrhoidal Preps
  • Motion Sickness
  • Respiratory Treatments
  • Stomach Remedies
  • Allergy & Sinus medicine
  • Anti-Diarrheals
  • Anti-Itch & Insect Bite
  • Baby Rash Ointments/Creams
  • Cough, Cold & Flu
  • Feminine Anti-Fungal/Anti-Itch
  • Laxatives
  • Pain Relievers
  • Sleep Aids & Sedatives
  • OTC medical supplies and equipment such as contact lens solutions, bandages, crutches, durable medical equipment or diagnostic devices, such as blood sugar test kits may continue to be purchased with the current SIGIS IIAS process.

Examples of some of the OTC items that will remain available without a doctor's prescription:

To purchase these items the consumer should just present their health benefit card at the time of the transaction.

  • Band Aids
  • Birth Control
  • Braces & Supports
  • Catheters
  • Contact Lens Supplies & Solutions
  • Denture Adhesives
  • Diagnostic Tests & Monitors
  • Elastic Bandages & Wraps
  • First Aid Supplies
  • Insulin & Diabetic Supplies
  • Ostomy Products
  • Reading Glasses
  • Wheelchairs, Walkers, Canes