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Over-the-Counter (OTC) Eligibility Changes Effective January 1, 2011

Many over-the-counter (OTC) items are eligible for purchase with your account funds. However, due to Patient Protection and Affordable Care Act (PPACA) regulations, some OTC drugs and medications will no longer be eligible for reimbursement after December 31, 2010, unless accompanied by a prescription*. Other items are considered “dual purpose” and are eligible only with a prescription, doctor’s directive or letter of medical necessity.

Please note, the eligibility of these items are subject to change pending further legal interpretation. Please check back for updated information. This information was last updated 12/16/2010.

Eligible without a Prescription – Insulin, testing, and other non-medicinal health items are available without a prescription, letter of medical necessity, or doctor’s directive. Examples include:

  • Bandages
  • Braces & Supports
  • Catheters
  • Contact Lens Supplies & Solutions
  • Denture Adhesives
  • Diagnostic Tests & Monitors
  • Family Planning Items
  • First Aid Supplies
  • Insulin & Diabetic Supplies
  • Non-Athletic Elastic Bandages & Wraps
  • Ostomy Products
  • Reading Glasses
  • Wheelchairs, Walkers, Canes

Eligible with a Prescription – Over-the-counter items that contain a drug or medication require a prescription in order to be reimbursed. Examples include:

  • Acid Controllers
  • Acne Products
  • Allergy & Sinus medicine
  • Antibiotics
  • Anti-Diarrheals
  • Anti-Fungal Foot Sprays & Creams
  • Anti-Gas Products
  • Anti-Itch & Insect Bite
  • Anti-Parasitic Treatments
  • Baby Rash Ointments/Creams
  • Cold Sore Remedies
  • Cough, Cold & Flu Treatments
  • Eye Medications
  • Digestive Aids
  • Feminine Anti-Fungal/Anti-Itch
  • Hemorrhoidal Preps
  • Laxatives
  • Motion Sickness
  • Nasal Sprays
  • Pain Relievers
  • Respiratory Treatments
  • Sleep Aids & Sedatives
  • Stomach Remedies

Dual Purpose Items – Items that can be used for a medical reason or for general health purposes are considered “dual purpose” and are eligible only with a prescription, doctor’s directive or letter of medical necessity. Examples include:

  • Dietary and Weight Loss Supplements
  • Fiber Supplements
  • Orthopedic Shoes and Inserts
  • Snoring Cessation Aids
  • Vitamins and Herbal Supplements

Expenses that are NOT Eligible – Expenses merely beneficial to general health or for cosmetic reasons are not eligible. Examples include:

  • Cosmetic Surgery
  • Cosmetics
  • Deodorant
  • Exercise Equipment
  • Fitness Programs
  • Hair Transplants
  • Illegal Operations & Treatments
  • Moisturizers & Wrinkle Creams
  • Teeth Whitening Services & Products
  • Toothpaste & Mouth Wash


ConnectYourCare is a member of SIGIS (Special Interest Group for IIAS Standards) and works within its standard.

*A “prescription” means a written or electronic order for a medicine or drug that meets the legal requirements of a prescription in the state in which the medical expense is incurred and that is issued by an individual who is legally authorized to issue a prescription in that state.