2011 FSA changes

[dr of rx]

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How are you going to deal with all of the potential OTC "scripts" this yr? (due to FSA changes ...thanks Obama)

I'm going to tell the people to buy the OTC item and submit to their insurance on their own.

Just what we need ..more work and more headaches.

Anyone need a flu shot? Haha ...

 

[MountainPharmD]

How are you going to deal with all of the potential OTC "scripts" this yr? (due to FSA changes ...thanks Obama)

I'm going to tell the people to buy the OTC item and submit to their insurance on their own.

Just what we need ..more work and more headaches.

Anyone need a flu shot? Haha ...

Why would you do that? You do realize the more scripts you do the more hours you get. It isn’t real hard to run an OTC item through the computer. The only problem I foresee is the chains will figure out a way to subtract these from your script count so it will not give you anymore hours. Right now everything run through the computer will increase your script count and therefore increase your hours.

I have been telling customers to get their OTC pseudofed on prescription for years. You do not have to fill out all the stupid paperwork and it counts in your scripts. Right now I do 60 to 70 PSE transactions a week and get no credit for them. PSE is a pain in the ass, takes forever to do the paperwork and can really back things up when we are busy. I would love to see all PSE products prescription only.

 

[spacecowgirl]

thanks Obama

🙄 really?

I think most people will find this too difficult and will just pay OOP. I don't think OTCs should have been eligible under FSA anyway so I have no issue with this change not do I think it will affect workflows that much.

 

[dr of rx]

The only problem I foresee is the chains will figure out a way to subtract these from your script count so it will not give you anymore hours.

why? you said it yourself, man.

they will count as OTC sales, or some crap like that. I'm sure we'll take it in the shorts with no extra profit for our store.

More phone calls, more register transactions, more calls, more faxes, more voicemail. More headaches. Same tech hours. Same profit.


I can hear the complaints already....



"I want the gel caps not tabs"

"call my Dr for the bigger bottle"

"I only take BRAND Advil!"

"call my Dr. I need some tylenol NOW"

"Claritin is on sale. I want 2 boxes"

"my cat prefers the redi-tabs"


Best of all, I can't wait for our first third party FSA claim audit.

 

[dr of rx]

🙄 really?

I think most people will find this too difficult and will just pay OOP. I don't think OTCs should have been eligible under FSA anyway so I have no issue with this change not do I think it will affect workflows that much.

Yes, really.

If making it harder for people to use their FSA accounts (and therefore raise more tax dollars) was not a democratic idea to help fund ObamaCare (I realize a very small amount) then where did it come from?

Same as you, I agree that FSA should not cover OTCs.

 

[Pharmavixen]

Let's see if I have this straight - new regs mean OTCs will be paid for, where they weren't before. This is a mistake, and ends up costing the system more than you can anticipate because people will go to their drs when they don't need to in order to get scripts for OTCs they are too cheap to buy off the shelf.

Where I live, the government delisted tons of OTCs, realizing millions in savings. I used to work next to a walk-in clinic, and a substantial portion of scripts were for stuff like Metamucil, bisacodyl tablets, Maalox/Gelusil, sunscreen (yes they paid for sunscreen!) etc because people were too cheap to just buy off the shelf. So the dr would bill for the pt visits, as well as the pharmacists' fees + cost of the drugs. Hugely wasteful use of health care resources - it was actually a left-wing government that ended up making the cuts to this system, in order to fund health care for, you know, actual sick people.

Some people argued against the delisting of, say, aspirin, because of 2ndary prevention of CV events in your cardiac pts. But those pts have turned out to be pretty compliant with buying their aspirin OTC. Cause aspirin is cheap.

 

[All4MyDaughter]

Let's see if I have this straight - new regs mean OTCs will be paid for, where they weren't before. This is a mistake, and ends up costing the system more than you can anticipate because people will go to their drs when they don't need to in order to get scripts for OTCs they are too cheap to buy off the shelf.

No. It just means if you want to use your FSA (flexible spending account) to pay for an OTC product, you have to get your doctor to write an RX for it. Previously, some people have been able to submit receipts for OTCs and get them reimbursed. But the money in an FSA is typically money the patient has paid in through payroll deduction. It's not funded by a third party.

Some OTC products are already covered on some insurance plans in the United States. Medicaid covers quite a few in my state. This has nothing to do with that.

 

[Pharmavixen]

Okay, thanks for the clarification. But if patients have to go to the dr to get a script for OTCs in order to get coverage, then the drs get to bill for the pt visit, no? Seems like this adds to health care costs, as pts who pay out of pocket for dr visits aren't going to do this.

 

[spacecowgirl]

Yes, really.

If making it harder for people to use their FSA accounts (and therefore raise more tax dollars) was not a democratic idea to help fund ObamaCare (I realize a very small amount) then where did it come from?

Same as you, I agree that FSA should not cover OTCs.

It's not a tax increase, it's repealing a tax break. I thought that's what people wanted, you know to help balance the budget and all.

 

[Ackj]

Where I live, the government delisted tons of OTCs, realizing millions in savings. I used to work next to a walk-in clinic, and a substantial portion of scripts were for stuff like Metamucil, bisacodyl tablets, Maalox/Gelusil, sunscreen (yes they paid for sunscreen!) etc because people were too cheap to just buy off the shelf. So the dr would bill for the pt visits, as well as the pharmacists' fees + cost of the drugs. Hugely wasteful use of health care resources - it was actually a left-wing government that ended up making the cuts to this system, in order to fund health care for, you know, actual sick people.

This definitely sounds like it will be a huge increase in health care spending. Granted not every plan has FSA, but still, things that were formerly OOP will come from healthcare funds. We actually had a few patients with leftovers in their account and ended up buying 100s of advil, vitamins, bandages just so it wouldn't go to waste. I guess the real issue is "what happens when the FSA is empty?" If they go back to paying copays OOP, then it's their fault for wasting the $ on vitamins when they could have been buying their RXs. If they get full coverage after, then that's a problem and is definitely going to be abused.

Plus side, we'll be able to keep track of OTC use and catch more interactions (warfarin/asa, plavix/ppi, etc) or at least have somebody tell them not to take 10 tylenol a day. Maybe there will even be a reduction in hospitalizations from it and a decrease in overall spending (I know, I know...)

 

[All4MyDaughter]

This definitely sounds like it will be a huge increase in health care spending. Granted not every plan has FSA, but still, things that were formerly OOP will come from healthcare funds. We actually had a few patients with leftovers in their account and ended up buying 100s of advil, vitamins, bandages just so it wouldn't go to waste. I guess the real issue is "what happens when the FSA is empty?" If they go back to paying copays OOP, then it's their fault for wasting the $ on vitamins when they could have been buying their RXs. If they get full coverage after, then that's a problem and is definitely going to be abused.

You realize that all of the funds in an FSA are directly funded by payroll deduction, don't you? That's why people have had to buy stuff at the end of the year. So they don't lose the money they contributed. After the money in the account is exhausted, you just go back to paying out of pocket. There is no net change in "health care spending" here. Except perhaps, as pharmavixen pointed out, the cost of more office visits if people have to go and get scripts for their OTC products.

 

[owlegrad]

This definitely sounds like it will be a huge increase in health care spending. Granted not every plan has FSA, but still, things that were formerly OOP will come from healthcare funds. We actually had a few patients with leftovers in their account and ended up buying 100s of advil, vitamins, bandages just so it wouldn't go to waste. I guess the real issue is "what happens when the FSA is empty?" If they go back to paying copays OOP, then it's their fault for wasting the $ on vitamins when they could have been buying their RXs. If they get full coverage after, then that's a problem and is definitely going to be abused.

Plus side, we'll be able to keep track of OTC use and catch more interactions (warfarin/asa, plavix/ppi, etc) or at least have somebody tell them not to take 10 tylenol a day. Maybe there will even be a reduction in hospitalizations from it and a decrease in overall spending (I know, I know...)

Very bright side thinking. 👍

I seem to recall filling OTC prescriptions as being pretty common, I don't know if changing FSA rules is really gonna make much of a change? I guess we will see.

 

[owlegrad]

You realize that all of the funds in an FSA are directly funded by payroll deduction, don't you? That's why people have had to buy stuff at the end of the year. So they don't lose the money they contributed. After the money in the account is exhausted, you just go back to paying out of pocket. There is no net change in "health care spending" here. Except perhaps, as pharmavixen pointed out, the cost of more office visits if people have to go and get scripts for their OTC products.

I seem to recall that many (most?) insurance companies will pay for OTC items that the pharmacy fills from a prescription. So I wonder if this FSA thing will pan out as expected? I mean if your doctor writes a prescription, then the pharmacy can bill your insurance, which seems even better than spending your FSA money, unless I am missing some critical piece here.

 

[All4MyDaughter]

Very bright side thinking. 👍

I seem to recall filling OTC prescriptions as being pretty common, I don't know if changing FSA rules is really gonna make much of a change? I guess we will see.

I don't think it's going to make much of a change. When I need some APAP I'm just going to buy it and not get reimbursed. Previously, I could submit receipts for my OTC products and now I can't, which sucks. But I'm not going to the trouble of going to the doctor for some APAP. For my higher ticket OTC items (like Zyrtec D) I will get an RX like I have been doing for years.

 

[owlegrad]

I don't think it's going to make much of a change. When I need some APAP I'm just going to buy it and not get reimbursed. Previously, I could submit receipts for my OTC products and now I can't, which sucks. But I'm not going to the trouble of going to the doctor for some APAP. For my higher ticket OTC items (like Zyrtec D) I will get an RX like I have been doing for years.

Yeah, that's pretty much exactly what I was thinking.

 

[All4MyDaughter]

I seem to recall that many (most?) insurance companies will pay for OTC items that the pharmacy fills from a prescription. So I wonder if this FSA thing will pan out as expected? I mean if your doctor writes a prescription, then the pharmacy can bill your insurance, which seems even better than spending your FSA money, unless I am missing some critical piece here.

Yes but there is by no means any type of universal standard for what OTC products various insurance plans will pay for. Mine pays for Zyrtec D (very high copay) and blood glucose test strips (with a $50 copay) but not lancets or the control solution. I've never tried to get anything like Tums or Delsym on my insurance. I have seen other insurance plans reject Nexium or generic omeprazole with the instructions "Use OTC Prilosec." A lot of plans dropped Claritin and Zyrtec when they went OTC. And so on...

 

[Ackj]

You realize that all of the funds in an FSA are directly funded by payroll deduction, don't you? That's why people have had to buy stuff at the end of the year. So they don't lose the money they contributed.

Excuse my ignorance, but why bother having one at all? Does your employer match your contribution, is it pre-tax income?

I seem to recall that many (most?) insurance companies will pay for OTC items that the pharmacy fills from a prescription. So I wonder if this FSA thing will pan out as expected? I mean if your doctor writes a prescription, then the pharmacy can bill your insurance, which seems even better than spending your FSA money, unless I am missing some critical piece here.

From the few times I've had OTC items on an RX, the insurance either says "product not covered" or "NDC rejected" with the exception of Medicaid. Once in a while we can give a cash price that's much cheaper than out in the store, for example 90 cetirizine for ~$12 compared to the same price for about 10. If we fill it for cash, they can use the FSA on it, of course.

Previously, I could submit receipts for my OTC products and now I can't, which sucks. But I'm not going to the trouble of going to the doctor for some APAP. For my higher ticket OTC items (like Zyrtec D) I will get an RX like I have been doing for years.

I'm not sure what the rules were previously for my family. I know most dr. offices got rejections when I tried to use the card to pay the copay, so we'd submit receipts. Same situation when picking up glasses and contacts. I didn't think we could buy OTC items, although I personally never tried.

 

[dr of rx]

It's not a tax increase, it's repealing a tax break. I thought that's what people wanted, you know to help balance the budget and all.

I never said it is a tax increase...because it is not.

It is not really repealing a tax break either...

It is adding extra steps to make it more inconvenient and difficult for people to take advantage of the program, therefore raising more tax revenue.

I don't use the program anyway. Just don't want more headaches because of this new wrinkle...

 

[owlegrad]

From the few times I've had OTC items on an RX, the insurance either says "product not covered" or "NDC rejected" with the exception of Medicaid. Once in a while we can give a cash price that's much cheaper than out in the store, for example 90 cetirizine for ~$12 compared to the same price for about 10. If we fill it for cash, they can use the FSA on it, of course.

I seem to recall it being quite a common practise. Besides all the common stuff (ASA, Ibuprofen, etc.) we also had an OTC shelf full of items we filled for various customers.

 

[owlegrad]

It is adding extra steps to make it more inconvenient and difficult for people to take advantage of the program, therefore raising more tax revenue.

Forgive me, I missed the part where this meant raising tax revenue?

 

[Pharmavixen]

Plus side, we'll be able to keep track of OTC use and catch more interactions (warfarin/asa, plavix/ppi, etc) or at least have somebody tell them not to take 10 tylenol a day. Maybe there will even be a reduction in hospitalizations from it and a decrease in overall spending (I know, I know...)

This was an argument used against delisting OTCs where I live.

I think overuse of APAP will occur whether it's OTC or rx. I recall a pt who was receiving a total of 3-4 g APAP/day from his various meds. I called the dr several times to try and stop this, and document on the script, and the pt would get abusive, nasty, etc. Anyway, he isn't bothering anybody anymore - he died of renal failure.

 

[PharmDstudent]

I would love to see all PSE products prescription only.

Hopefully that's where it's headed.

 

[Farmercyst]

Excuse my ignorance, but why bother having one at all? Does your employer match your contribution, is it pre-tax income?
From the few times I've had OTC items on an RX, the insurance either says "product not covered" or "NDC rejected" with the exception of Medicaid. Once in a while we can give a cash price that's much cheaper than out in the store, for example 90 cetirizine for ~$12 compared to the same price for about 10. If we fill it for cash, they can use the FSA on it, of course.

I'm not sure what the rules were previously for my family. I know most dr. offices got rejections when I tried to use the card to pay the copay, so we'd submit receipts. Same situation when picking up glasses and contacts. I didn't think we could buy OTC items, although I personally never tried.

I know my FSA was pre-tax. I used it to pay for my LASIK 5 years ago, before elective surgeries were taxed. So I was able to use pre-tax money to pay for an untaxed procedure and saved on both sides.

Most of the people we have on FSA now use a "wageworks" card where the deduction comes straight from their FSA and no receipt is required. I forget who runs that plan, but it seems pretty convenient. I think they can get audited, but it's done on the patient level so the only work it creates for us is if we have to look up an old receipt or print an rx summary. This happens maybe 10 times per year.

 

[MountainPharmD]

why? you said it yourself, man.

they will count as OTC sales, or some crap like that. I'm sure we'll take it in the shorts with no extra profit for our store.

More phone calls, more register transactions, more calls, more faxes, more voicemail. More headaches. Same tech hours. Same profit.


I can hear the complaints already....



"I want the gel caps not tabs"

"call my Dr for the bigger bottle"

"I only take BRAND Advil!"

"call my Dr. I need some tylenol NOW"

"Claritin is on sale. I want 2 boxes"

"my cat prefers the redi-tabs"


Best of all, I can't wait for our first third party FSA claim audit.

First off the pharmacy would not be audited on the FSA claims. The patient would just like they are now.

Second, it is not at all difficult to run a prescription through for Tylenol that says use as directed per package instructions. Having the OTC information in the patients profile will help catch drug interactions and the like.

Lastly, not many people use FSA's anyway. Most companies are now going to HSA'S which have different rules. Basically this is tightening up the rules on FSA'a in order to decrease a tax break some are getting. Your FSA contributions lower you taxable income, which means you pay less federal income tax. I am sure some smart bean counter up in Washington has calculated X millions of dollars will be saved by eliminating OTC's. How many people do you think are going to bother going to their Doctor to get scripts for Tylenol? I guess not many.

 

[MountainPharmD]

Hopefully that's where it's headed.

The PSE manufactures lobbied hard to have thier products stay OTC. That is the only reason they are not prescription only. PSE can be easily abused so why shouldn't it be a prescription? Isn't a drugs abuse potential the very definition of why drugs are controlled. PSE should be a schedule 5 drug avaiable only through presciption. It would end all this time wasting nonsense at the pharmacy and it might actauully do something to decrease the production of meth. The process we have in place now is a joke.

 

[dr of rx]

First off the pharmacy would not be audited on the FSA claims. The patient would just like they are now.

How can you be so sure? I have plenty of customers that complain that they must fill out additional paperwork, etc for FSA claims. (Waste of their time IMHO)

I am sure we will have to 'verify claims' etc. Any time a third party is involved in a transaction, being audited is always a possibility.

Second, it is not at all difficult to run a prescription through for Tylenol that says use as directed per package instructions. Having the OTC information in the patients profile will help catch drug interactions and the like.

It is not difficult to run most scripts thru. Difficulty is not my concern. The increase in workload for no benefit is my issue.

Lastly, not many people use FSA's anyway.

speak for yourself.....I see many of my customers use them. I hope they don't want to be bothered with the new procedure.

I wonder that the MD/DO/PAC think about this....I'm sure they don't want to be bothered with it either.