New Reform Rule Could Increase Prescription Requests

Persons with health savings accounts (HSAs) and similar flexible spending accounts will now be required to have a prescription for some of the most standard over-the-counter (OTC) drugs if they want to get reimbursed.

The regulation, the result of the Accountable Care Act (health care reform), took effect Jan. 1, 2011, and will likely increase the demand on physicians and medical practices for prescriptions.

Prior to 2011, patients with HSAs were reimbursed for OTC medications without a prescription. The new regulation requires a prescription for all OTC medications and supplies with the exception of certain exceptions, such as, glasses, contacts, bandages, and blood sugar devices.

Electronic prescribing can significantly reduce the undue burden that this legislation places on physicians and medical practices. Medicare continues to offer a bonus for physicians who successfully ePrescribe in 2011. Learn more about the 2011 requirements for the ePrescribing incentive.

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Comments: 9


I understand why the new law was inacted..the way it was, you could have used the HSA's for anyone else's OTC items..neighbors, friends, etc. You could have even purchased for them in exchange for cash. Even though it is certainly a p.i.a. for docs, it really does make sense. I know this is not a popular opinion but generally, things that are abused get taken away.

judy d at 2/3/2011 4:11:41 PM


Your IRS, not your government is mandating the change. The IRS is a government agency concerned with accounting, it is not the government. Second, may I please remind you commentors that FSA money is lost if not spent within one year. Before this rule, the FSA provider for my employer routinely refused claim submissions and would require us to submit forms with every denial. (Talk about paperwork!) We would be threatened with stress-inducing time limitations for submission mandating the forms be faxed by a certain date or we would lose access to our own money. This new rule is meant to protect consumers (patients) like me. Today a NP refused to write a script for the OTC meds my son needed for children's pain and allergy relief meds, even though we were told he needed those items for his current condition. Her reasoning was that she could not bill for the prescription. Is this what medical professionals go to school to do? Bill? Without regard for the needs of the patient? What happens when I lose my FSA money due to refusals such as this? Have any of you considered the needs of your patients?

FSA-card holding teacher at 1/25/2011 4:46:29 PM


Why would our government want to continue to heap on more levels of worthless rules to make doing my job more combersome and difficult and costly it takes me at least 45 seconds to write any prescription even one that takes no thought multiply 45 X 2000 patients X 2 to 3 otc prescriptions and you tally between 50 and 55 hours. then add the cost to supervise and regulate the new rules and you should be able to understand that this will cost every american time and money. where is the upside to this rule

anonymous at 1/11/2011 7:47:24 AM


I think the lay-public thinks that to write an Rx (or multiple) is simply the time required to write it. Not so in mostly all cases. I need to pull the chart, review for interactions (or make sure it is not a duplicated agent, and many times review specialty notes to see who made the recommedation to add this OTC agent. This is laborious to do it properly. When will the prio-authorization process start with OTC agents to 'jusitfy' the expenditure to their flex accounts? I agree with a visit to at least capture a billable moment for these services. anonymous

anonymous at 1/10/2011 12:45:42 PM


We all need to individually refuse to write those OTC prescription unless, as Dr Kressley suggested , that the patient come into the office for a prescription. We can not continue to lay down as welcome mats and have mandates placed upon us to complicate our professional lives and increase our (med-mal)) exposure. I went to medical school to become a physician not a provider !!

anonymous at 1/8/2011 3:28:37 PM


Just one more unfunded mandate that will primarily hit primary care practices. I for one, will not write OTC prescriptions for patients who are not in the office. As part of a visit, if I suggest an OTC medication, than I will be happy to write or e-prescribe the medication through my EHR. I do not want to be responsible for patients combining, or inappropriately using OTC medications not according to directions, AND I do not have time to add this to my list of things to do. If they want the Rx, they can come in to review their medication list and I will write the Rx but ONLY if the visit is medically appropriate. This is especially a problem in pediatrics, where OTC meds are often used inappropriately. This also has the potential to increase our medical liability (does the PMS have a stance on this?) and increase the amount of unnecessary health care expenditures. One other question, if pharmacists can technically "order" vaccines to give in the pharmacy, why can't THEY write a prescription for an OTC medication?

Sue Kressly, MD at 1/6/2011 5:34:54 PM


Just more of the same. We (as physicians) have been pushed around for decades and we just continue to "take it" as part of our job (unreimbursed). There will be a breaking point when enough physicians leave practice (or retire early) and the younger generation sees the errors of medicine's (esp. Primary Care) ways and decides not to enter into PC Medicine.

anonymous at 1/6/2011 3:39:53 PM


Does PaMed have an opinion an whether practices can no charge for this service? If I understand E/M coding correctly level of service can be dictated by writting prescription for prescription medications? Does this apply for prescriptions that I have to write for OTC nonprescription medications?

anonymous at 1/6/2011 3:30:05 PM


Why the AMA (and PMS) doesn't have a policy aas to how physicians should react to this already is disappointing. This has the potential to greatly increase the already sizable non-reimbursed work physicians have. As for the comment regarding electronic prescribing, I believe that is naive. Someone in the office has to take the time to input the data. This takes away personel from the day-to-day funstions of the office.

Fred Becker, MD at 1/6/2011 3:28:47 PM

Last Updated: 1/5/2011
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