Requests for OTC prescriptions for a FSA burdens primary care

As reported by MSNBC, the federal government will no longer allow flexible spending accounts (FSAs) to be used for over the counter medications, without a prescription. FSAs, which are offered by many employers, allow you to use tax free dollars for medical expenses that aren’t covered by your insurance. FSAs are a great idea and can be used for things like eye glasses, dentistry, or even nicotine patches for smoking cessation.

The people most likely affected by this rule are those that take over the counter medications on a regular basis. Examples of such medications include pills for allergies, heartburn , aspirin for heart attack prevention, and smoking cessation aids. Medical supplies like insulin syringes and crutches, though sold over the counter, are exempted.

Now, you might think, “no big deal, I will just call my doctor and ask her to call in a prescription for a baby aspirin a day.” This would certainly solve your problem, but it adds to your physician’s problem and is a perfect example of the problems with the reimbursement system for health care, particularly for primary care.

If you are not aware by now, procedures get reimbursed much more than just talking to patients, which is why cardiologists make so much more than primary care physicians. However, anything that doesn’t happen in an office visit is generally not reimbursed at all. Primary care physicians can be great managers of your health care, done in a way that it convenient for you, and at a low cost — phone calls, emails, forms, etc. Problem is that the few minutes spent on you add up and take a whole lot of time. None of which is reimbursed by health care insurances under the current system. One doctor started adding these things up, and of the 50-60 hours each week the doctor put in, each day they:

  • Handled 23.7 phone calls
  • Answered 16.8 e-mails, mostly dealing with test result interpretations
  • Dealt with 19.5 lab reports, 11.1 imaging reports and 13.9 consult reports
  • Issued 12.1 prescription refills, excluding those issued during patient visits

None of these are reimbursed.

Now, here’s the real kicker about asking your doctor for an aspirin prescription. Not only are you compounding this problem, but you are also doing it not for better care (or any care for that matter), but so you can save money.

Finally, consider this.

Even though you can easily go to CVS and get aspirin on your own, if your doctor writes you a prescription for aspirin, legally speaking it is a whole different ball of wax. By writing a prescription, even if only for an aspirin, your doctor is rendering medical care. He is required by law to accurately document this. He is also liable for this care. If you had an adverse reaction to the aspirin prescribed, you could certainly sue.

Thus, by asking for a prescription for an aspirin, you are asking for the doctor to deliver care which he is liable for, which he will not get paid for, which (when added up for each patient) will take time away from true patient care and for the sole purpose of you saving yourself a few bucks.

Now, one of the reasons that primary care physicians have gotten into the mess that we are in is because we generally want to do what’s best for the patient and have been delivering this kind of free care for a long time. We actually were glad to do it, and only started complaining recently when what we got paid for actual care kept declining while our specialist colleagues kept getting more money, and our paper work started to increase. Many of us (probably including myself) will likely grant these requests without a complaint.

The point of this post was not to prevent your from requesting an OTC prescription from your physician for tax purposes. After all, the economy is still horrible and many patients truly need daily medications for allergies and heartburn that are quite expensive. The point is that are entire health care reimbursement system must change, and must change very soon. A few requests for OTC prescriptions for FSAs on top of perpetually threatening Medicare cuts might be all it takes for a primary care physician to stop practicing medicine altogether.

Matthew Mintz is an internal medicine physician and blogs at Dr. Mintz’ Blog.

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