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Family Forum / Parenting / Parenting / March 2007prescribing OTC medications
I'm sure I've heard of doctors prescribing stuff like children's multivitamins, which one can buy straight off the shelf and I guess the user then buys direct that works out cheaper, or fills the prescription if that is cheaper or free. DS needed some cream, I was not entirely convinced that this was the right cream, so wasn't keen to pay for it and asked the doctor to prescribe it (we get our prescriptions free), she refused, muttering something like "we're recommended not to do that". The way I see it, is that if you have insurance that pays things like that, that you are either paying more for it, or being paid less in your job to account for the good benefits, we're not desparately strapped for cash, it's not a case of cream for DS, or food or anything like that, but we are having to watch our pennies closely, am I being unreasonable to expect that something like this should be prescribed? I mean, this is hydrocortisone for a spot the doc says is eczema, but say he had it over large portions of his body, you'd get through a tube jolly fast, where do they draw the line where they would prescribe it! Anne > I'm sure I've heard of doctors prescribing stuff like children's > multivitamins, which one can buy straight off the shelf and I guess the > user then buys direct that works out cheaper, or fills the prescription if > that is cheaper or free. The only vitamins that we had a prescription for for my child were ones that were NOT available OTC. One time my doctor wrote me a prescription for a particular cough syrup, and I took it to the pharmacists. He said to me "oh, this is an OTC medication now, no longer needs a prescription" and because it was OTC, the insurance will NOT pay for it...so even if your doctor did write you a script for it, the insurance is likely not going to pay for it anyway. Besides that, in practical terms, most insurance policies have a set dollar limit of prescription coverage per year and if you go over it they won't pay any more than that amount ($500 per year with my policy), so why waste your prescription coverage on something like hydrocortisone cream that its OTC? My OB wrote me a prescription for prenatal vitamins where there was an OTC equivalent-but at the time I had insurance which covered prenatals 100%, so by getting them from the pharmacy (which literally just slapped a pharmacy label on the same box you could buy OTC), the insurance paid. I've also had prescriptions written for naproxyn when leaving the hospital post-partum where the nurse told me that "if it's cheaper, just take 3 OTC strength ones instead of one prescription strength-it's the same dosage". One one insurance plan, it was cheaper to fill the script, on the other it was cheaper to just buy OTC. > My OB wrote me a prescription for prenatal vitamins where there was an > OTC [quoted text clipped - 8 lines] > One one insurance plan, it was cheaper to fill the script, on the other it > was cheaper to just buy OTC. It also occured to me that, even if you had to pay the prescription price because it wasn't covered, you might pay less, particularly on some meds, I'm thinking a large pack of generic allergy meds, rather than a small pack of branded stuff. Anne > I'm sure I've heard of doctors prescribing stuff like children's > multivitamins, which one can buy straight off the shelf and I guess the [quoted text clipped - 14 lines] > through a tube jolly fast, where do they draw the line where they would > prescribe it! I have found that when our doc prescribes things you can get OTC, like mucinex, it doesn't mean the insurance will then pick it up. YMMV, but that's how it is with our carrier, which is a cigna. Aula > I'm sure I've heard of doctors prescribing stuff like children's > multivitamins, which one can buy straight off the shelf and I guess the user [quoted text clipped - 15 lines] > > Anne I can't comment on your specific question but you can charge it to your flexible spending account since it's a medication (even OTC medication). So atleast it's tax free. > I can't comment on your specific question but you can charge it to > your flexible spending account since it's a medication (even OTC > medication). So atleast it's tax free. hmm, we don't have one, as our insurance is very good, so we didn't think we would need it, perhaps we need to look into it, dependent on what kind of things you can charge to it, it may well be worth it. Anne > I can't comment on your specific question but you can charge it to > your flexible spending account since it's a medication (even OTC > medication). So atleast it's tax free. What is a flexible spending account? We have an optional tax deferred comp that we can set aside annually, but whatever isn't spent on items not covered by insurance *for which one has a bill* revert to the employer. So, I set aside only what I believe we will use. This year's $935 went to braces for DS, last year's went to part of my deductible and out of pocket expenses related to rotator cuff repair surgery. But, it won't pay out of pocket expenses like OTC meds. -Aula >> I can't comment on your specific question but you can charge it to >> your flexible spending account since it's a medication (even OTC [quoted text clipped - 7 lines] > expenses related to rotator cuff repair surgery. But, it won't pay out of > pocket expenses like OTC meds. Are you sure? They generally do pay for OTC meds. You just have to keep receipts. It's true that you lose the money you don't use, so you don't want to go overboard, but there are quite a few expenses that typically qualify. Best wishes, Ericka > Are you sure? They generally do pay for OTC meds. > You just have to keep receipts. It's true that you lose the > money you don't use, so you don't want to go overboard, but > there are quite a few expenses that typically qualify. Hmmmm...I will have to re-read the propaganda from the program. This is all new to me with the 'new' job and I'm still learning the in's and out's of it all. Between having a non-HMO after over using them exclusively for nearly 20 years, and now this deferred comp program, I am learning a lot. Not sure that I wanted to, mind you, but times and things change, you know. -Aula >> Are you sure? They generally do pay for OTC meds. >> You just have to keep receipts. It's true that you lose the [quoted text clipped - 6 lines] > 20 years, and now this deferred comp program, I am learning a lot. Not sure > that I wanted to, mind you, but times and things change, you know. Definitely look at the plan details, and call someone if you need to. I tend to save receipts for OTC meds and other nickel-and-dime stuff just in case we end the year with money to burn in the account. Best wishes, Ericka > Definitely look at the plan details, and call someone > if you need to. I tend to save receipts for OTC meds and other > nickel-and-dime stuff just in case we end the year with money to > burn in the account. I'll google to try and find out more, but if you have a moment, any possibility you could give me a quick run down of what kind of things might be able to be use this kind of account for. I pay for drop in day care for my physical therapy appointments, is there any chance that could count? Similarly uncovered medical treatment (say acupuncture), or the cash payment I have to make on my glasses and so on... Anne >> Definitely look at the plan details, and call someone >> if you need to. I tend to save receipts for OTC meds and other [quoted text clipped - 4 lines] > possibility you could give me a quick run down of what kind of things might > be able to be use this kind of account for. You probably need to talk to your specific plan. > I pay for drop in day care for my physical therapy appointments, is there > any chance that could count? Probably not. > Similarly uncovered medical treatment (say > acupuncture), or the cash payment I have to make on my glasses and so on... Those should be ok. Best wishes, Ericka > You probably need to talk to your specific plan. Thanks for the answer Ericka, shame I can't get care for dependents covered when attending appointments, I'm not asking for it to be paid for, just a tiny tax break, it's quite a big expense for me at the moment, 200 dollars or so a month and with the number of appointments I'm needing at the moment, I can't arrange for them to be when DH can mind the kids or entirely when DS is in preschool and so on, barring wierd happenings I shouldn't need that many for too much longer (which might actually turn out to be more costly, I'll still need to do the exercise and pilates is something that's difficult to do without being in a class as a minimum). Anyway, I rather think this is something we would have needed to have made a decision on in November for this year, but for next year, it may well be worth putting a tiny bit into. Anne >> You probably need to talk to your specific plan. > [quoted text clipped - 7 lines] > I'll still need to do the exercise and pilates is something that's difficult > to do without being in a class as a minimum). You should definitely check--it might fly. There are also dependent care accounts, but I think you can only use those if you're getting care to allow you to work. > Anyway, I rather think this is something we would have needed to have made a > decision on in November for this year, but for next year, it may well be > worth putting a tiny bit into. Sure. Spend this year keeping track of things so that you have a better idea what would work for next year. Best wishes, Ericka >> Definitely look at the plan details, and call someone >> if you need to. I tend to save receipts for OTC meds and other [quoted text clipped - 4 lines] > possibility you could give me a quick run down of what kind of things > might be able to be use this kind of account for. You have to check your plan, but the list is often identical (or tracks quite closely) to the IRS list of deductible medical expenses. You can download the publication from the IRS website, the title is something like "Medical and Dental Expenses." That should give you an idea. Amy > I'll google to try and find out more, but if you have a moment, any > possibility you could give me a quick run down of what kind of things [quoted text clipped - 4 lines] > acupuncture), or the cash payment I have to make on my glasses and so > on... From what a brief re-read of the benefits coverage lists I find that since I am not part of an HMO I must include an explanation of benefits from the insurer to make most claims. Some claims, like durable equipment, must be accompanied by a specific form outlining Medical Necessity, and cosmetic treatments must also be included by the same documentation. The catch with these plans, other than loosing what you don't use in the same year, is that you also have that money coming out of every paycheck, so you have to calculate how much you expect to have in expenses against how much you dare reduce your paycheck per pay period.My formulas might not be what others would choose, but that's part of how we all tend to see things differently and come up with variances on solutions. =Aula >> I'll google to try and find out more, but if you have a moment, any >> possibility you could give me a quick run down of what kind of things [quoted text clipped - 8 lines] > am not part of an HMO I must include an explanation of benefits from the > insurer to make most claims. They're looking to make sure you're not double dipping. If your insurance covers it, then you may not deduct it. Your co-pays or any other payments that you make for medical care that are not reimbursed should be eligible. Different companies that administer these plans ask for different levels of documentation. OTC drugs should be covered, since the IRS started allowing those as deductible expenses somewhere around 2003. The tricky bit is that some companies may have specific requirements (perhaps a receipt specifically naming the drug). Others require less documentation. > Some claims, like durable equipment, must be > accompanied by a specific form outlining Medical Necessity, and cosmetic [quoted text clipped - 5 lines] > would choose, but that's part of how we all tend to see things differently > and come up with variances on solutions. True. On the whole, if you know you're going to spend the money, you're well ahead to use the reimbursement account (especially if you don't have enough medical expenses to be able to deduct them on your taxes). Generally, it's easier to have it spread out over the course of the year rather than arriving in big, unpredictable chunks. The tricky bit is making sure you don't get left holding the bag without allowable expenses to cover all you've had withheld--which is no mean feat. Best wishes, Ericka > <tednee...@yahoo.com> wrote in message > [quoted text clipped - 13 lines] > > -Aula Hi, I haven't read most of the thread but I just wanted to clarify few things. I think we are talking about the same thing. Where I'm, there are two segments in flexible spending accounts. Health care reserve account (HCRA) and Dependent care reserve account (DCRA). There are both controlled by the law. The government decides which items can be reimbursed in this category, not your insurance company. I think employers are required to provide info on this. Here's the link to IRS. http://www.irs.gov/publications/p502/ar02.html#d0e323 > Hi, I haven't read most of the thread but I just wanted to clarify few > things. I think we are talking about the same thing. Where I'm, there [quoted text clipped - 6 lines] > Here's the link to IRS. > http://www.irs.gov/publications/p502/ar02.html#d0e323 While that's technically true, the company managing the savings account can have policies that make it difficult to be reimbursed for some things. E.g., although they should cover OTC meds, they might insist that in order to reimburse, you provide a receipt that shows the name of the medication on the receipt. Depending on where you bought it, that might be difficult to procure. Best wishes, Ericka > I'm sure I've heard of doctors prescribing stuff like children's > multivitamins, which one can buy straight off the shelf and I guess the user [quoted text clipped - 15 lines] > > Anne I have to admit, how American of you! What I'm inferring is that your Rx co-pay is cheaper than the cost of the OTC, so you'd rather not pay the OTC but instead just have the Rx cost pooled into your company's total pharmacy costs, resulting in a higher insurance premium at some future point? I have to admit, I can quite well understand the response of your MD, and also understand the whole approach of the consumer when the incentives/disincentives are stacked the way they are.... My stance is that OTC meds shouldn't be prescribed, as the Rx claims applied to your provider group are affected by this. I also feel that I can quite understand the desire to just have the insurance pick it up -- but ask, if you do that, that you never again say that it's inconceivable how people in the US can't afford health insurance, as I think you've just hit on one of the drivers. Caledonia > I have to admit, how American of you! Odd, since I'm English. > What I'm inferring is that your Rx co-pay is cheaper than the cost of > the OTC, so you'd rather not pay the OTC but instead just have the Rx [quoted text clipped - 10 lines] > inconceivable how people in the US can't afford health insurance, as I > think you've just hit on one of the drivers. I can see the logic, but on this particular insurance it really does not have that knock on effect, the "insurance" we have is really not actually insurance, it's administered as such, but it all comes out of company money, so whilst from a users perspective it is exactly like insurance, if costs go up, more money is put in, not premiums going up, as no one (not even dependents) pays a premium. You could argue the same on the British system, the "co-pay" if you pay for prescriptions is likely to be more expensive for something that is available over the counter, but many many people get free prescriptions and many others purchase prepayment cards which are equivalent to the cost of only a small number of prescriptions. I never even thought to question my doctor when he prescribed things for both me and my kids that I could have bought, I presume the logic is that it means there is no excuse for the person to not actually get the medicine and also reduces chances of errors, for example here, there are antifungal creams that have the same name as other skin creams, that just have AF at the end, you could easily end up with the wrong one. Quantity is another issue in the UK, which I don't think is the case here, in the UK you can only buy 32 paracetamol OTC or 16 off the shelf, which is 4 and 2 days supply, I used to get prescriptions for 100. There are lots of things that you can buy, but can get provided, such as walking aids or wheelchairs. I seem to recall that US women often get sanitary towels provided after they have a baby, they can quite clearly be bought. Perhaps we should start expecting relatives to bring s meals whilst in hospital - this is the norm in some countries. Whilst I do see the logic of the arguement if you can buy it you should, when you realise quite how many things it applies to there has to be a line somewhere. Other thoughts that occured, was that if parents are regularly told just to go and buy something then maybe next time they won't take there child to the doctor, I was actually quite surprised that hydrocortisone was available to buy, I don't think it is in the UK and it certainly strikes me as something that the use of ought to be directed by a doctor. (Just looked it up, seems it is available to buy in the UK). I think what really grated me in this particular instance is that I think the doctor is recommending the wrong cream, for a child that has never had any eczema to suddenly have a tiny patch in an unsual place (on the base of his rib cage), that looks very like ring worm that is starting to heal, that is eczema and hence hydrocortisone being the correct treatment strikes me as a little odd, so I'll be very frustrated if that turns out to be the case and I also have to go and get antifungal cream, particularly as we've never had any cause to use hydrocortisone cream, so it will likely sit on the shelf until it's use by date, at least antifungal cream we would use, we just happen to be out, hence having not already tried it and given we were at the doctors, why I had her look at the mark. The UK health system is clearly far from perfect, I'd be interested to know if not prescribing drugs that are available OTC has ever been discussed and if so, why the system has remained as it is, with doctors routinely prescribing such drugs. Anne > > I have to admit, how American of you! > > Odd, since I'm English. I know -- it's just a very American behavior. > > What I'm inferring is that your Rx co-pay is cheaper than the cost of > > the OTC, so you'd rather not pay the OTC but instead just have the Rx [quoted text clipped - 17 lines] > up, more money is put in, not premiums going up, as no one (not even > dependents) pays a premium. My only question is where is the 'more money' coming from? if premiums go up (and the company covers 100% of the premium), isn't that affecting the 'cost' of hiring an employee? Or influencing the f/t (benefit-eligible) versus p/t decision? At the very least, if it's a publicly-traded company, it's affecting shareholder value. (some snip) > There are lots of things that you can buy, but can get provided, such as > walking aids or wheelchairs. I seem to recall that US women often get [quoted text clipped - 3 lines] > of the arguement if you can buy it you should, when you realise quite how > many things it applies to there has to be a line somewhere. Too true. At the end of the year, your health insurance premium -- whether paid by your company, your spouse's company, Shareholder Stuart, or Uncle Sam -- is influenced by the buying decisions you, the patient, have made. I just think that people don't see the whole circle of 'how their behavior influences cot,' especially if the cost is all-but-transparent to them. People do bring meals to individuals who are self-pay patients here -- the surcharge for meals is too high, as they're marked up to cover the cost of providing meals to the uninsured (who in many cases can't afford health insurance). Caledonia > My only question is where is the 'more money' coming from? if premiums > go up (and the company covers 100% of the premium), isn't that > affecting the 'cost' of hiring an employee? Or influencing the f/t > (benefit-eligible) versus p/t decision? At the very least, if it's a > publicly-traded company, it's affecting shareholder value. we're talking very large, very profitable company, health insurance is a drop in the ocean, it's already substantially better than any other scheme I'm aware of (for example, first company to provide anything towards the cost of corrective eye surgery). I do realise that they have to limit and having seen more sides of the debate, I don't feel this company should go out on a limb and pay for OTC medication when it seems no other providers do, I'm just not entirely convinced about the whole thing, particularly for under 16s. All health care is free for under 16s in the UK, when over 16s pay for prescriptions, a proportion of dental care and all eye care, and probably some other things, I think the logic is that if children are to get decent care then you've got to pay for it, it's all too easy for an adult to take a decision that a child doesn't really need a particular medication and for the costs of that illness to escalate due to a hospital stay or something. I'm sure the vast majority of parents wouldn't behave like that, but a significant number will and if you then add in the number of mistakes that could be made with parents buying the wrong thing, I'm not sure the sums necessarily work out that it's cheaper, there might be no need for "more money", but instead money redirected. Anne > > My only question is where is the 'more money' coming from? if premiums > > go up (and the company covers 100% of the premium), isn't that [quoted text clipped - 6 lines] > I'm aware of (for example, first company to provide anything towards the > cost of corrective eye surgery). I think I know the company. I think the cost of health insurance remains a 'drop in the ocean' as those costs are managed down (it's an open question whether this is good or bad, depending on where one sits) by using independent contractors and outsourcing work to places with far lower benefit costs....truly, it's all connected. (I'm not on the 'outsourcing and independent contractors are bad' bandwagon, but do believe that insurance costs are a component of these decisions. Or at least, they've been publicly stated as a component of these decisions.) >I do realise that they have to limit and > having seen more sides of the debate, I don't feel this company should go [quoted text clipped - 13 lines] > > Anne There are ~9 million children in the United States without health insurance, and SCHIP is not making the biggest dent in this figure. You've summed it up well, "if you want decent care, then you've got to pay for it." Caledonia How much do you think it costs to do the paperwork involved in health care insurance? You obtain a service; the service provider collects your insurance information (makes a photocopy of your card, creates a billing record), submits the bill to the insurance; the insurance sends you a letter stating the billed amount, the approved amount, the insurance paid amount, and how much is left for you to pay; the service provider sends you a bill. Or should I say, at least one bill. If the insurance takes too long, the service provider bills you several times before you know how much you are supposed to pay them. Now do all this for a $10 tube of some OTC lotion, or an ordinary box of bandaids (sticking plasters) and you have spent easily $20 or $30 in processing costs. The American system puts the consumer in the loop to contain costs, but that has its own costs. > I'm sure I've heard of doctors prescribing stuff like children's > multivitamins, which one can buy straight off the shelf and I guess the user [quoted text clipped - 15 lines] > > Anne I don't have much experience in the private insurance world since most of my prescribing history is either in a single large HMO or in publicly insured clinics. But from what little experience I do have, a doctor's prescription doesn't matter for over the counter meds if you have private insurance. There are often closely related meds that have OTC and Rx cousins -- different formulations of vitamins, various nonsedating antihistamines (Claritin vs Allegra), or different formulations of hydrocortisone (1% vs. 2.5%). In California, Medicaid (public insurance for the poor) will cover OTC with a prescription. If your coverage includes that, it's the first time I've heard of it for private coverage. Otherwise you'd have to step up to a significantly stronger cream to get it by prescription. Kate, ignorant foot soldier of the medical cartel and the Bug, 3 and a half |
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