OTC Prescription Requests

OTC Prescription Requests for FSA – Reimbursement: An Additional Burden for Primary Care Physicians

By Lynn Tubman, CPA — Senior Healthcare Consultant, Snyder Cohn Healthcare Division

By now, many primary care physicians are probably already dealing with a large influx of requests from their patients for written prescriptions for over-the-counter medications. Effective January 1, 2011, the Affordable Care Act revised the definition of the types of medical expenses that can be reimbursed through FSAs, HRAs, and HSAs to include only prescribed medications (with the exception of medical supplies, i.e., crutches, insulin syringes, etc.). Now, in order for over-the-counter medications to be reimbursable under these accounts, a prescription must be obtained from the individual’s primary care physician. Primary care physicians are already squeezed for time, and the additional burden of fulfilling these requests could greatly impact not only the profitability of their practices but the amount of time available for them to spend with their patients. Also, providing prescriptions for over-the-counter medications could create additional malpractice liability issues for PCPs. Should a patient have an adverse reaction to a prescribed over-the counter medication, a lawsuit could follow. What can PCPs do to mitigate the huge amount of paperwork, hassle, and potential liability that has arisen from this recently enacted change? If your office hasn’t already done so, consider implementing the following:

1. Charge a fee for each over-the-counter prescription request. For example, a $10 charge for each prescription may very well outweigh the financial benefit of getting the paper Rx and could serve to greatly reduce requests for infrequently used and/or less expensive medications.

2. Institute a new policy stating that prescriptions for OTC medications can only be requested during a regularly scheduled appointment. At that time, the physician can write the scripts for all OTC medicationat one time.

3. Consider only writing prescriptions for patients with chronic conditions (i.e. heartburn, allergies, and headaches) and try to do this only during a scheduled appointment. The office should post its policy regarding over-the-counter medication prescription requests in a conspicuous area of the office, as well as on the practice website. Whatever policy the practice decides on, make sure that it is followed consistently, and that the staff is trained to properly educate the patients on the policy. Unfortunately, some patients will undoubtedly be upset with whatever policy implemented; however, it is important that physicians protect themselves and the viability of their practices by following policies that makes sense, both time and cost-wise, to all involved.