Take care® by wageworks - the otc drug prescription requirement
The OTC Drug Prescription Requirement
Tell Me About .
In order for over-the-counter (OTC) drugs such as Claritin, Advil, and Robitussin to be reimbursed from your health care account, you need a prescription. This became effective January 1, 2011, as part of the Affordable Care Act. When consulting with your health care provider, please remember that the prescription must meet the respective state requirements and include the brand name of the drug (e.g., Zyrtec) or the drug’s category (e.g., cetirizine). See the instructions below for details of how to file a claim for a prescribed OTC drug and the fol owing FAQ for more information about the prescription requirement.
How to submit a claim for a prescribed OTC drug
1. Go to www.takecareWageWorks.com and log into your account.
2. Go to “Request Payment” tab.
3. Fill in all the information requested on the “Create Claim” page, fol ow instructions.
4. Review your receipt. If it includes the prescription number, it can be submitted without the
prescription. If it does not include the prescription number, you will need to submit the prescription along with the receipt.
5. Scan receipts, prescriptions (if necessary), EOBs and other supporting documentation.
6. Attach supporting documentation to your claim by using the upload utility.
Note: If you have a Card transaction that requires verification, you will receive notification with instructions to resolve the transaction.
To speed processing, remember to save receipts that show exactly what you paid for, the amount and date of service. Most claims are processed within one to two business days after they are received, and payments are sent shortly thereafter.
If you prefer to submit a paper claim by fax or mail, you can go to www.takecareWageWorks.com to download a Pay Me Back claim form and fol ow the instructions for submission.
Answers to commonly asked questions about
the OTC Drug Prescription Requirement
Q. What exactly needs to be submitted when filing a claim for an over-the-counter drug that
requires a prescription?
When filing a claim for a prescribed over-the-counter drug, you need to submit a copy of the
prescription and an itemized cash register receipt that includes the date, amount, provider name and OTC item or the itemized receipt that also includes the prescription number.
Q. Will you accept a receipt that has a prescription number but no drug name?
Yes. It will be accepted as long as the prescription number, patient name and purchase date
Q. Can a single prescription be used more than once or for multiple purchases and/or claims?
Yes, but it depends on how the prescription is written. If the prescription indicates a one-time use,
it can be used just that one time. If the prescription indicates that the medication is to be taken as needed, it can be used perpetual y for up to one year from the date it was written. If the prescription treats a temporary condition, it will only be valid for 30 days.
My Health Care Toolkit
Q. If I’ve already submitted a prescription for an expense, do I need to resubmit it with subsequent claims?
No, if you are submitting what is basical y a refil , you do not need to resubmit your prescription. We retain your prescription for one year.
Q. Can I ask my doctor to write a single prescription for multiple over-the-counter items?
Yes, a single prescription can contain multiple categories or drug products, but will only be accepted for Pay Me Back claims. For best results,
you should obtain a separate prescription for each item.
Q. Will you accept a prescription that indicates multiple refills?
Yes, a prescription with multiple refil s is acceptable.
Q. How specific does a prescription need to be? For example, is “pain killer” sufficient?
The prescription does not have to be specific to a product or name brand. A general OTC category, such as ibuprofen, is sufficient. However,
if the prescription is a specific brand or indicates “dispense as written,” only the indicated brand name and dosage and count will be accepted.
Q. If a prescription contains a specific drug name, can it be applied to any over-the-counter drug in the same category?
For example, what if the prescription states Prevacid and the item purchased is Zantac?
Yes, as long as the prescription is not written “dispense as written”, substitute items in the same category will be accepted.
Q. Can I submit a Letter of Medical Necessity instead of a prescription?
No. Based on current guidance, a Letter of Medical Necessity will not satisfy the Rx requirement. The prescription must be issued pursuant to
Q. Can I use my take care® Card to purchase prescribed over-the-counter items?
Yes, if a valid prescription is presented at the time of purchase and the purchase is made at a pharmacy counter and dispensed as a
prescription item. With the law, OTC drugs and medicines have been removed from the list of eligible items that you can purchase with the Card at the general merchandise checkout counter. To use your Card at a pharmacy, you will need to present the prescription along with the OTC medicine to a pharmacist; the pharmacist then dispenses and processes the purchase of the OTC medicine in accordance with applicable law. If the pharmacy has an inventory system that meets industry standards (I AS), then the purchase is classified as a prescription, and no further action is required. If a purchase is made at a non-I AS pharmacy, then FSA and HRA participants will need to submit either the receipt listing an Rx number or the prescription along with a receipt detailing the purchase for verification.
Q. Can I submit a prescription that was written and filled in a foreign country?
Yes. We will continue to accept prescriptions that are written and fil ed for use in a foreign country. Imported drugs are not eligible as
2012 WageWorks, Inc. All rights reserved. WageWorks® is a registered service mark of WageWorks, Inc. Throughout this document, “savings” refers only to tax savings. No part of this document constitutes tax, financial or legal advice. Please consult your advisor regarding your personal situation and whether this is the right program for you.
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