Microsoft word - new otc drug guide 5-page 11.2.2010.doc

Over-the-Counter Drug Eligibility: The recent Health Care Reform legislation introduced new plan provisions to Health Care Reimbursement Accounts. The first new provision to take effect is the change in eligibility of over-the-counter items. Effective January 1, 2011, over-the-counter (OTC) drugs and medicines (other than insulin) will require a prescription or Letter of Medical Necessity in order to qualify as an eligible medical expense under health care reimbursement accounts that allow OTC. Insulin purchased over the counter will continue to be eligible for reimbursement. The new provision impacts the use of health benefit cards; please review the Health Care Reimbursement Accounts Important Upcoming Changes communication for additional information. This list of OTC items will be updated once the official listing of acceptable over the counter items is communicated. Eligible OTC Expenses: products that alleviate or treat injuries or illness.
Type of Drug
Common Brands
Acne Free  Acnomel  Ambi Even & Clear  Bye Bye Blemish  Clean & Clear  Clearasil  Murad Acne Complex Kit  Nature’s Cure Acne Treatment  Neutrogena Acne Treatment  OXY  Proactiv Solution  Stri-Dex  ZAPZYT Acne Treatment  Zeno Acne Clearing Device Actifed  Allerest  Benadryl  Chlor-Trimeton  Claritin  Contac  NasalCrom  Aspirin  Advil  Aleve  Bayer  Excedrin  Ibuprofen  Midol  Motrin  Naprosyn  AXID AR  Gas-X  Maalox  Mylanta  Pepsid AC  Prilosec OTC  Rolaids  Bacitracin  Neosporin  Triple Antibiotic Ointment Femstat 3  Gynelotrimin  Mycelex-7  Monistat 3  Vagistat-1 Ex-Lax  Immodium AD  Kaopectate  Pepto-Bismol Actidil  Actifed  Allerest  Benadryl  Claritin  Chlor-Trimeton  Contac  Dimetabe  Drixoral  Sudafed  Tavist  Triaminic Bactine  Benadryl  Caldecort  Caladryl  Calamine  Cortaid  Hydrocortisone  Bronitin Mist  Bronkaid  Bronkolixer  Primatene Mist Abreva Cream  Blistex  Carmex  Herpecin Actifed  Advil Cold and Sinus  Afrin  Afrinol  Aleve Cold and Sinus  Alka Seltzer Cold and Flu  Children’s Advil Cold  Contac  Dayquil  Dimetane  Dristan, Drixoral  Neo-Synephrine, Nyquil,  Otrivin  Pediacare  Sudafed  Tavist-D  Thera-flu  Triaminic  Tylenol Cold and Flu  Cough Drops  Nasal Sprays  Lozenges Cleaning and Soaking Solutions  Lens Storage Cases  Bausch & Lomb, Boston, Opti-free, Allergan, Renu Ovulation Predictor Kits  Pregnancy Tests  Spermicides  Condoms  Trojans  Robitussin  Vicks 44  Chloraseptic  Mucinex  Cough Drops  This is a representative list of items authorized for reimbursement from health reimbursement accounts that allow OTC medicines/supplies. Remember to always check for generic and shop for specials. Eligible OTC Expenses: products that alleviate or treat injuries or illness for you and your dependents.
Type of Drug
Common Brands
Eye Drops  Eye Patches  Reading Glasses  Ocu-Hist  Clear Eyes  Visine Ace Bandages  Antiseptics  Band-aids  Bandages  Bandage Tape  Cold/Hot Packs for Injuries  First Medical Gloves  Joint Supports (ankle, elbow, knee, wrist)  Liquid Adhesives  Peroxide  Rubbing Alcohol  Splints  Thermometers  Witch Arch and Insole Supports  Callous Removers  Athlete’s Foot Products (see antifungal)  Bunion, Blister and Corn Treatments Purell  Germ-X  Nexcare (This does not include soaps, lotions, or other personal hygiene items that include sanitizing ingredients; they are not eligible. NOTE: You may need to submit a detailed receipt (showing the product name). If your receipt does not show the product name, you must also include a copy of the product label Preparation H  Hemorrhoid  Tronolane Blood Pressure (monitor and related equipment)  Cholesterol  Colorectal Screenings  Crutches  Diabetic Equipment and Supplies  Glucose Tester  HIV Test  Ovulation Kits  Pregnancy Tests DairyCare  Dairy Relief  Lactaid  Lacteeze  Lactrase BenGay, Tiger Balm, Flexall, Absorbine Junior Services and Bracelets for Medical Information Blistex Medicated Lip Ointment  Carmex Medicated Lip Balm  Neosporin Lip Advil Migraine  Excedrin Migraine  Motrin Migraine Breathe Right  Snorezz (NOTE: Nasal strips to alleviate snoring or reduce nasal Sunscreen products with a SPF of 30+  Aloe Vera Commit  Nicotine Gum  Nicorette  Nicoderm CQ  Nicotrol Compound W  Dr. Scholl’s Clear Away  Wart-Off This is a representative list of items authorized for reimbursement from health reimbursement accounts that allow OTC medicines/supplies. Remember to always check for generic and shop for specials. Dual Purpose OTC Medicines and Products may be reimbursed under health reimbursement accounts
(that allow OTC medicine and products) with a completed letter of medical necessity stating your specific
diagnosis or medical condition, a recommendation to take the specific OTC medicine to treat your
condition, length of treatment and documentation of the product and cost.
 Anti-baldness/hair loss/hair replacement – such as Rogaine, but only if to replace hair loss due to a medical condition (e.g., cancer treatment) and not for balding due to age.  Calcium (ex: Calcium Carbonate, Caltrate, Tricalcium, Phosphate, Calcium Citrate, Calcium Lactate,  Dietary Supplements (ex: Protein bars, Power drinks, Ensure, Glucerna)  Fiber supplements (ex: Benefiber, Metamucil)  Healing Ointment (ex: Aquaphor, Eucerin)  Herbal supplements used to treat a specific disease – such as St. John's Wort for depression  Medicated shampoos to treat a specific medical condition like psoriasis and only the amount in excess  Minerals (ex: Calcium, Caltrate, Ferrous Sulfate, Feosol, Slow FE, Folic Acid)  Vitamins are not an eligible expense, unless prescribed by a physician to treat a specific medical condition (i.e., Iron to treat, not prevent, anemia; Calcium Supplements to treat, not prevent, Osteoporosis) – a doctor's note detailing the specific medical condition will be required for reimbursement This is a representative list of items authorized for reimbursement from health reimbursement accounts that allow OTC medicines/supplies. Remember to always check for generic and shop for specials. OTC Items Not Reimbursable. The following OTC medications or products are not considered medical
care and are not reimbursable through a health reimbursement account.
 Face soaps/creams, make-up, moisturizers, eye creams, and wrinkle reducers  Feminine Hygiene Products such as tampons and maxi pads  Vitamins (without a letter of medical necessity) Over-the-Counter Drug Eligibility: The recent Health Care Reform legislation introduced new plan provisions to Health
Care Reimbursement Accounts. The first new provision to take effect is the change in eligibility of over-the-counter items.
Effective January 1, 2011, over-the-counter (OTC) drugs and medicines (other than insulin) will require a prescription or
Letter of Medical Necessity in order to qualify as an eligible medical expense under health care reimbursement accounts
that allow OTC. Insulin purchased over the counter will continue to be eligible for reimbursement. The new provision
impacts the use of health benefit cards; please review the Health Care Reimbursement Accounts Important Upcoming
Changes communication for additional information.
A Letter of Medical Necessity form can be downloaded from www.careflexexpress.com. A completed prescription and/or
Letter of Medical Necessity will be kept on file at CareFlex for the duration of a plan year. A new prescription or Letter of
Medical Necessity is required to be submitted every plan year.
Over-The-Counter Medicines and Products
Over-the-counter (OTC) medicines and products are reimbursable under Health Care Reimbursement Accounts that
allow OTC when the OTC product is used for medical purposes. (Please check your plan documents to determine if
your health reimbursement account allows the purchase of OTC medicines and products.) CareFlex allows the same
expenses as those allowed by the IRS. Below is a description of the three IRS-defined categories:
Eligible OTC Medical Care Expenses:
Eligible items include medicines or products that alleviate or treat injuries or illness. These drugs and products are not
cosmetic in nature, or merely beneficial to general health. Claims for OTC medicines and products must include a
physician’s prescription or completed Letter of Medical Necessity and an adequate receipt accompanied by a
Reimbursement Request form. An adequate receipt states the name of the medicine or product, the date, and the amount
paid. If your supermarket or pharmacy receipt does not include this information, you will need to copy the label from the
product or its packaging, circle the correct amount on your receipt, and submit this information with your signed
Reimbursement Request form.
Dual-Purpose Products:
Certain OTC products are considered dual-purpose, such as vitamins and supplements. This is because for some
individuals, the product is used to alleviate a medical condition, while others use the product for general health and well-
being. These products may be eligible for reimbursement, but require a Letter of Medical Necessity stating your
specific diagnosis or medical condition, a recommendation to take the specific OTC medicine to treat your
condition, and documentation of the product and cost. Please note: submitting a Letter of Medical Necessity for
your claim does not guarantee that the expense will be approved.

Excluded Items:
OTC products that are not medicines or that merely benefit your general health are NOT reimbursable (such as vitamins) without a Letter of Medical Necessity. Reimbursement for OTC medicines still follows the existing rules regarding health reimbursement accounts. The expense(s) must:  Be incurred during your period of coverage.  Not be reimbursed through another plan.  Be substantiated by a detailed receipt.
How Can I Submit My Request For Reimbursement?
Claims can be entered by the participant online through the Participant Portal or can be emailed, faxed or mailed to: CareFlex Benefit Solutions
205 West Dares Beach Road
Prince Frederick, Maryland 20678
Phone: 888-577-2762  Fax: 410-414-8432  Email: [email protected]
Instructions for Online Claim Entry can be found under the Download Forms link at www.careflexexpress.com.

Source: http://www.careflex.com/PDFs/NewOTCDrugGuide5pg11_2_2010.pdf