Most OTC products, excepting some medical equipment like crutches and diabetic supplies, now cannot be purchased with flexible spending account dollars without a physician prescription.

One of my partners asked last week how I am dealing with this issue.  He has had several patients ask for a long list of prescriptions for OTC products so that they can use their FSP to pay for these things with pre-tax dollars.  This puts us in a no-win situation.  Either we spend the time to write several prescriptions for whatever the patient asks for or spend a similar amount of time explaining why we decline to write the prescriptions.

It is very likely that this is a great example of the law of unintended consequences.  The law was clearly written to increase tax revenue. The unintended consequence is that patients are now asking for a prescription for things like aspirin, Tylenol, body lotion, dandruff shampoo, shoe inserts and nearly anything else you can imagine.  Here are some of the issues I have with this situation:

• Even in the highest tax brackets the savings for some of these items just are not worth my time to write and document a prescription:  Aspirin cost $2.   Tax savings potential  $0.66
• This is one more task added to the primary care physicians to do list after patients are seen to accomplish before we can go home.  It takes at least 30 seconds to open a patient’s chart, write a prescription, and get the Rx to a patient’s pharmacy or to leave at the front desk for them to pick up.   Patients often ask for prescriptions for multiple items, some requiring more time than just writing a prescription.
• These requests use up minutes in a patient visit that can be better used for other care.  Do I want to spend my time gathering enough information to help a patient adjust their insulin and eating to control their blood sugar, or writing prescriptions for their corn pads, aspirin, body lotion and anti-perspirant.
• Once a physician writes a prescription they incur some liability for the product used.  Let’s say a patient uses a product that they ask me to prescribe.  If they then have a problem in any way related to that product you can bet my name will be added to the list of defendants in the product liability lawsuit.
• I really don’t know about much about many of the OTC products patients use.  Some of the herbal and supplement products used have labeling that is nearly indecipherable, and certainly nothing I would ever recommend.  Should I now be writing a prescription for these as a money saving service to patients?  I think I’ll say no to these requests.

Really this new law is a good example of a decision made with one intended consequence that leads to another unintended consequence.  In this case the government is responding to concerns about the cost of health care, so they have tried to save costs to the government by eliminating the pre-tax status of some OTC products. By doing so they have increased primary care physician overhead costs.  This is likely a false savings.  It is certainly poor use of primary care physician’s time and is unlikely to be an incentive for new medical school graduates to choose primary care over higher paying specialty care where few of these prescription requests will be seen.

Edward Pullen is a family physician who blogs at DrPullen.com.

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