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, 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
Expense Description	Standard FSA	Limited-purpose FSA	HRA	Required Documentation
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 (e.g., for bug bites and poison ivy: 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