Expanding access to affordable health care was the goal of the Patient Protection and Affordable Care Act (ACA), but the way the law treats OTC medications is a burden to patients and physicians.
Patients who want to use their health savings accounts (HSAs) or flexible spending arrangements (FSAs) to pay for such medications must present a prescription at the time of purchase. The AAFP and other members of the broad-based Health Choices Coalition sent letters(2 page PDF) Jan. 30 supporting action in the House(www.congress.gov) and Senate(www.congress.gov) to change the rule.
Letters were sent to Reps. Lynn Jenkins, R-Kan., and Ron Kind, D-Wis., sponsors of the Restoring Access to Medication Act of 2017, which would allow patients to use their HSAs and FSAs to purchase OTC drugs without having to visit a physician for a prescription. Similar letters were sent to sponsors of the Senate companion bill, Sens. Pat Roberts, R-Kan., and Heidi Heitkamp, D-N.D.
"Prohibiting the use of FSA funds to purchase these medicines or requiring documentation from a doctor that OTCs are being used to treat a medical condition limits access and greatly reduces the cost efficiencies associated with these medicines," the coalition wrote.
A 2010 survey(www.yourhealthathand.org) found that a majority of patients and physicians preferred self-care interventions, including the use of OTC medications, as a first response for minor ailments.
An estimated 50 million Americans now use an HSA or an FSA to pay for medications and other health care costs that are not covered by their insurance plans. Requiring them to show prescriptions for OTC medications means physicians and pharmacists must handle prescriptions that would not otherwise be required.
"We believe this provision on the use of tax-preferred accounts for the purchase of OTC medicines has resulted in unintended consequences to both physicians and patients," the coalition members wrote.
The letters emphasize that the goals of the ACA were to increase access to care and lower the total cost of care, goals which are supported by affordable OTC drugs. These medications save the health care system $102 billion annually, according to a 2012 report(www.yourhealthathand.org) -- savings of $6 to $7 for every dollar that is spent on OTC medication.
"Unfortunately, the provision that limits coverage of OTC medicines instead increases overall costs to the health care system and places an administrative burden on already overburdened physician offices," the letters stated.
The coalition, which represents physicians, dentists, consumers, retailers, manufacturers, pharmacists, patients, insurers, small businesses and large employers, has pressed lawmakers to repeal the provision since it took effect in 2011.
Related AAFP News Coverage
AAFP Renews Efforts to Repeal OTC Provision in Health Care Reform Law