Saturday, January 1, 2011

The OTC Jungle, Revisited

New regulations in 2011 will no longer allow people to purchase over the counter medications with their health care flex-spending debit cards, unless their physician has written them a prescription for that OTC product. Even then, the rules for reimbursement will vary among insurance plans --- my own plan, for instance, still requires a different method of payment and for me to manually submit items, including a copy of the prescription, to them.

It's going to be interesting to see how this plays out. First of all, we need people to know how their own plan handles this, and we all know how splendidly it works out when we ask people to understand their own insurance. (Not.) There are going to be lots of people who will be asking US to get those prescriptions FOR them, as in "Can you call my doctor and get a prescription for Robitussin DM and how-long-will-that-take and when-can-I-pick-it-up," etc. And even though we are using technician and pharmacist time to process these as prescriptions, we have been told that ultimately we will still charge only the OTC price, because that is what other pharmacies are doing (....true?) So the time we spend fiddling around with this will be free.

We have a good proportion of customers who use these FSA debit cards, and I feel sure that none of them will know about this change. I seldom claim for OTC's myself --- I don't buy that many and I tend to throw out the receipt without thinking. Is it worth the trouble? Get the generics, clip the coupons, and ask your friendly pharmacist if it's worth the price. If they wanted to change the rule, maybe it should have been no more OTC claims, with or without a 'prescription.' Save the paperwork. We've got enough already.


pharmacy chick said...

this could prove to be the biggest crapola since the pseudoephedrine fiasco of a few years ago. No, I will not call physicians to get rx's for otc items. If you are so cheap that you want an fsa card to pay for a $1.29 bottle of aspirin then you do the work. I have bigger fish to fry before they stink up the pharmacy.

Sarah said...

Agreed! I mentioned this to my pharmacy manager a few months back (it was news to him) and told him we needed to have a firm policy in place before the new year and that it was my personal opinion that we not cater to this ridiculous scenario at all. All I got was a "hmm" in response, so we shall see how it pans out. I know that when I am working, there will be no calling the dr for on OTC rx, period.

lovinmyjob said...

What really bugs me about this is that most people had to sign-up for 2011 flex spend accounts in november and weren't informed that this change was coming. It probably would have influenced their decision. It seems to me like one more way for that flex-spend money to be "lost" at the end of the year. Believe me its not "lost" at all, someone knows where it is.

C said...

What a waste of your time. I'm so sorry.

I never fill 800mg Motrin prescriptions. I just take 4 200mg pills. I know my insurance will cover it but my time is more valuable.

Jenny said...

I work in the Benefits department of a large company (and have been in benefits for years) and this change in the law is absolutely absurd. I realize I am commenting on a relatively old post, but it still makes me mad. Especially when you consider the wasted dollars spent visiting the doctor's office to get a prescription for your Claritin, Prilosec, whatever -- or in the case of the inconsiderate patrons who ask you to call for them, the wasted effort on your part and the wasted $35 surcharge they will incur for "prescription call in" by the doctors office.

oh, and lovinmyjob -- someone or everyone in the benefits department at your work should be fired if they truly did not inform participants during Open Enrollment. This little change came about with the major Healthcare Reform in March 2010 and if they didn't know to tell you, they are incompetent.