FSA + HRA Over-the-Counter Eligible Expenses

FSA + HRA Over-the-counter Eligible Expenses

The following table provides examples of over-the-counter drugs and health care items that may be reimbursable through your plan under certain circumstances or if specific requirements are met.

IMPORTANT: Not all expenses are eligible under all plans. Refer to your Summary Plan Description (SPD) to find out which expenses are eligible under your plan.

Supporting Documentation for OTC Expenses
All requests for reimbursement for OTC expenses must include the appropriate supporting documentation.

  • For over-the-counter medicines: A written or electronic OTC prescription along with an itemized cash register receipt that includes the merchant name, name of the OTC medicine or drug, purchase date, and amount, OR a printed pharmacy statement or receipt from a pharmacy that includes the patient's name, the Rx number, the date the prescription was filled, and the amount.
  • For over-the-counter health care-related products: An itemized cash register receipt with the merchant name, the name of the item/product, date, and amount.

Credit card receipts, canceled checks, and balance forward statements do not meet the requirements for acceptable documentation.

For some expenses, a Medical Determination Form from a doctor may be required.


Over-the-Counter Expense List

Expense
Description
Expense Eligibility Required
Documentation
Standard FSA Limited-purpose FSA HRA
Acetaminophen (e.g., Tylenol) Yes No Yes Standard + Prescription
Acne treatments (e.g., Clearasil, Proactiv) Yes No Yes Standard + Prescription
Allergy medicine (e.g., Actifed, Benadryl, Claritin, Zyrtec) Yes No Yes Standard + Prescription
Antacids and acid relievers (e.g., AXID AR, Gas-X, Maalox, Mylanta, Pepcid AC, Prilosec OTC, Tagamet HB, TUMS, Zantac 75) Yes No Yes Standard + Prescription
Anti-itch lotion and cream (for bug bites and poison ivy, e.g., Benadryl Cream, Calamine Lotion, Caldecort, Cortaid, Hydrocortisone) Yes No Yes Standard + Prescription
Antidiarrheal and laxatives (e.g., Ex-Lax, Imodium A.D., Kaopectate, Pepto-Bismol) Yes No Yes Standard + Prescription
Antifungal cream (e.g., Fenstat 3, Gyne-Lotrimin, Lamisil AT, Lotrimin AF, Micatin, Monistat 3, Vagistat-1) Yes No Yes Standard + Prescription
Antihistamine (e.g., Actifed, Allerest, Chlor-Trimeton, Contac, Dimetane, Drixoral, NyQuil, Tavist-1, Triaminic) Yes No Yes Standard + Prescription
Aspirin (e.g., Bayer, Excedrin) Yes No Yes Standard + Prescription
Bandages Yes No Yes Standard
Blood pressure monitoring devices Yes No Yes Standard
Burn garment Yes No Yes Standard
Carpal tunnel wrist supports Yes No Yes Standard
Chondroitin sulfate Potentially No Potentially Standard + Medical Determination Form
Cold medicines and decongestants (e.g., Advil Cold and Sinus, Afrin, Aleve Cold and Sinus, Children's Advil Cold, Neo-Synephrine-12 Hour, Sudafed, Tavist-D, Tylenol Cold and Flu, Theraflu) Yes No Yes Standard + Prescription
Cold sore remedies (e.g., Abreva, Campho-Phenique, Releev, Zicam) Yes No Yes Standard + Prescription
Condoms and other contraceptive devices Yes No Yes Standard
Contact lens solution (e.g., Aosept, Allergan, Bausch & Lomb, Boston, Opti-Free, Renu) Yes Yes Yes Standard
Cough suppressants (e.g., Chloraseptic, Delsym, Mucinex, Robitussin, Triaminic, Vicks 44) Yes No Yes Standard + Prescription
Diabetic supplies, test kits, and strips Yes No Yes Standard
Diaper rash ointments and creams (e.g., Balmex, Desitin) Yes No Yes Standard + Prescription
Diarrhea medicine (e.g., Ex-Lax, Imodium A.D., Kaopectate, Pepto-Bismol) Yes No Yes Standard + Prescription
Ear plugs Potentially No Potentially Standard + Medical Determination Form
Eye drops for allergy and cold relief (e.g., OcuHist, Visine) Yes No Yes Standard + Prescription
Feminine antifungal and anti-itch creams (e.g., Fenstat 3, Gyne-Lotrimin, Vagistat-1) Yes No Yes Standard + Prescription
Fiber supplements (e.g., Benefiber, Metamucil) Potentially No Potentially Standard + Medical Determination Form
First aid cream, ointment, and spray (e.g., Bactine, Neosporin) Yes No Yes Standard + Prescription
First aid kits and supplies (e.g., ACE bandages, BAND-AIDS, bandage tape, gauze, medical gloves) Yes No Yes Standard
Gauze pads Yes No Yes Standard
Glucosamine Potentially No Potentially Standard + Medical Determination Form
Glucose monitoring equipment Yes No Yes Standard
Glucose tablets and gel Yes No Yes Standard + Prescription
Hearing aids and hearing aid batteries Yes No Yes Standard
Hemorrhoid treatments (e.g., Preparation H, Tronolane) Yes No Yes Standard + Prescription
Herbs and Herbal Supplements (e.g., St. John's Wort) Potentially No Potentially Standard + Medical Determination Form
Hot and cold packs Yes No Yes Standard
Ibuprofen (e.g., Advil, Motrin) Yes No Yes Standard + Prescription
Incontinence supplies (e.g., Depends, Serenity) Yes No Yes Standard
Insect bite creams and ointments (e.g., Benadryl cream, Calamine lotion, Cortaid, cortisone cream) Yes No Yes Standard + Prescription
Insulin (over-the-counter) Yes No Yes Standard
Lactose intolerance products (e.g., Lactaid) Yes No Yes Standard + Prescription
Laxatives (e.g., Correctol, Dulcolax, Ex-Lax, MiraLAX, Senokot) Yes No Yes Standard + Prescription
Liniments (e.g., BENGAY, Flexall, Tiger Balm) Yes No Yes Standard + Prescription
Mastectomy-related special bras Yes No Yes Standard
Medic Alert bracelet or necklace Yes No Yes Standard
Medical monitoring and testing devices Yes No Yes Standard
Medicated shampoo (to treat a specific medical condition like psoriasis, e.g., Dermarest shampoo) Potentially No Potentially Standard + Medical Determination Form
Menstrual pain relievers (e.g., Midol, Pamprin, Premsyn PMS) Yes No Yes Standard + Prescription
Migraine pain relievers (e.g., Advil Migraine Liqui-gels, Excedrin Migraine) Yes No Yes Standard + Prescription
Motion sickness pills (e.g., Dramamine, Marzine) Yes No Yes Standard + Prescription
Nasal sprays Yes No Yes Standard + Prescription
Nasal strips (nose strips) Potentially No Potentially Standard + Medical Determination Form
Nicotine gum or patches (e.g., Commit, NicoDerm CQ, Nicorette, Nicotrol, Nicodin) Yes No Yes Standard + Prescription
Occlusal guards Yes Yes Yes Standard
Over-the-counter supplies Yes No Yes Standard
Pain relievers (e.g., Advil, acetaminophen, aspirin, ibuprofen, Motrin, Tylenol) Yes No Yes Standard + Prescription
Pedialyte and other oral electrolytes Yes No Yes Standard + Prescription
Pediculicide (head lice treatment, e.g., Nix, RID) Yes No Yes Standard + Prescription
Poison ivy protection (e.g., Ivy Block) Yes No Yes Standard + Prescription
Pregnancy test kits Yes No Yes Standard
Prenatal vitamins Yes No Yes Standard + Prescription
Reading glasses Yes Yes Yes Standard
Rubbing alcohol and alcohol pads Yes No Yes Standard + Prescription
Sinus medicines (see decongestants) Yes No Yes Standard + Prescription
Sleep aids (e.g., Sominex, Sleepinal, Tylenol P.M., Unisom Sleep Tabs) Yes No Yes Standard + Prescription
Snoring cessation aids and medications (e.g, Breathe Right Spray, Snoreeze) Potentially No Potentially Standard + Prescription
Spermicidal foam Yes No Yes Standard + Prescription
Sunburn creams and ointments (e.g., Aloe Vera Gel, Solarcaine) Yes No Yes Standard + Prescription
Sunscreen and sun block with SPF 15 or greater Yes No Yes Standard (itemized receipt must show SPF value)
Sunscreen and sun block with SPF less than 15 Potentially No Potentially Standard + Prescription
Supplies to treat medical condition Yes No Yes Standard
Thermometers Yes No Yes Standard
Throat lozenges and cough drops (e.g., Cepacol, Chloraseptic, Halls, Sucrets) Yes No Yes Standard + Prescription
Toothache and teething pain relievers (e.g., Orajel) Yes No Yes Standard + Prescription
Vitamins (to treat a specific medical condition, e.g., calcium to treat osteoporosis; iron to treat anemia) Potentially No Potentially Standard + Medical Determination Form
Walker, wheelchair, cane Yes No Yes Standard
Wart remover treatments (e.g., Tinamed) Potentially No Potentially Standard + Prescription