IRS Says Flexible Spending Accounts Can’t Reimburse OTC Drugs Without Prescription

Employees who want to pay for over-the-counter medications using their health care flexible spending account (FSA) will need a prescription to do so effective January 1, 2011, according to new Internal Revenue Service (IRS) rules.

The rules issued September 3 involve a section of the health care reform law that sharply restricts FSA reimbursements for over-the-counter medications such as nonprescription pain relievers, cold medicines, antacids and allergy medications. What was not clear, though, was whether a doctor’s note was enough or whether a prescription was required for an FSA to reimburse over-the-counter purchases, said Sharon Cohen, an attorney with Towers Watson & Co. in Arlington, VA.

The IRS says a prescription is required for over-the-counter reimbursements. It defines a prescription as a “written or electronic order for a medicine or drug that meets the legal requirements of a prescription in the state in which a medical expense is incurred and that is issued by an individual who is legally authorized to issue a prescription in that state.”

The IRS also resolved uncertainty involving the new over-the-counter restriction on what are known as “grace period” FSAs. Under rules the IRS issued in 2005, unused contributions made to FSAs in the current year can be rolled over to pay for expenses incurred during the first 2½ months in the following year.

The new IRS rules say over-the-counter reimbursements are banned for grace-period FSAs and FSAs without grace periods, effective January 1, 2011, said Mark Berggren, benefits outsourcing counsel with Hewitt Associates Inc. in Lincolnshire, IL. ◆