got a prescription for that tylenol?

I was interested to read a story in the Wall Street Journal (WSJ) last week about some unintended consequences of the Affordable Care Act.

 I am referring to the section that requires patients to obtain a prescription for over-the-counter (OTC) drugs if they want to be able to use their health care flexible spending account (FSA) to pay for it. Apparently many people are requesting this and many physicians, especially pediatricians, are finding it cumbersome. Pediatricians are often in the position of treating multiple children in the same family for the same illness. They would have to write a separate script for each child and each requested drug, even if its a drug they wouldn't actually recommend for a particular child (remember the previous post on the over-use of OTC cold preparations in young children?  The physician may be taking on additional risk, if the child should have an adverse reaction to a "prescribed" OTC medication

In addition, if a debit card from the FSA will be used to pay for the non-prescription drug, a pharmacist has to generate a label, and do all the other stuff they normally do to process a prescription drug. 

Certainly the pharmacists are not happy with this situation. Inevitably it will add cost to our already costly system.

One of the foci of the WSJ article is that many physicians are starting to charge an additional amount for the over-the-counter prescriptions, which will not be payable by the FSA, and might be more than the tax savings one would realize from using the FSA to pay for the cost of the drug.

I am not aware of physicians locally charging these fees; nor have I heard many complaints from my physician colleagues. But then again, I haven't been asking.

Is this a problem for you?

Whether you are a provider or a parent, I would love to hear your perspective.

In my family, our uncovered co-pays and other charges for medical, dental and ophthalmologic care usually exceed the total amount of my FSA for the year, so I have no reason to submit the costs of over-the-counter drugs. But I am sure that for some families, health care out of pocket costs may not be that high, and they may need to use all drug costs, including those for over-the-counter medications.

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About Dr. Ackerman

Alice Ackerman, MD, MBA, FAAP, FCCM is the Chair of the Department of Pediatrics at Carilion Clinic and Professor and Founding Chair of Pediatrics at the Virginia Tech Carilion School of Medicine. Dr. Ackerman is recognized nationally as an expert in pediatric critical care.

She has been at Carilion Clinic since June of 2007. Her primary goals are to enhance the health care of children in the Roanoke Valley and Southwest Virginia, and is actively working to do this both as physician in chief of the children's hospital, as well as through involvement with many state-wide initiatives.

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