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Flexible spending gets more rigid

October 04, 2010 By: Nadia Category: HealthCare, Medicine Advice, Medtipster, Prescription News, Prescription Savings Source: Chicago Tribune | 10.1.2010 | By Gregory Karp

Beginning Jan. 1, you'll need a prescription to purchase over-the-counter drugs tax-free

If you have a health care flexible spending arrangement (FSA), commonly known as a flexible spending account, through your employer, it’s about to become less flexible.

The coming change means you might want to alter your FSA contribution during this year’s open-enrollment period for health benefits. New federal regulations that take effect Jan. 1 require a prescription for drugs and medications purchased with FSA money, limiting purchases you can make tax-free.

The same rules apply to health reimbursement arrangements (HRA), health savings accounts (HSA) and the less-common Archer medical savings accounts (MSA).

That means no more tax-free purchases of over-the-counter cold and flu medications, pain relievers and allergy meds without a prescription. The prohibition is part of the Affordable Care Act enacted in March.

The good news is the new rule pertains only to drugs and medicines. You can still buy over-the-counter medical supplies. So, besides such purchases as crutches, medical-testing kits and joint supports, you can still use FSA money for standard medicine cabinet stock, such as Band-Aids, contact lens solution and hearing-aid batteries. Some plans allow the purchase of suntan lotion with a sun protection factor (SPF) of more than 30 and even hand sanitizer. Big-ticket expenses such as eyeglasses and teeth braces are still allowed. And the new rule specifically exempts reimbursements for the cost of insulin, which you can still buy without a prescription.

If you have an FSA available through your employer, here’s what you need to know.

* FSAs are still a good deal. An FSA is a benefit typically offered by large employers to help workers defray medical costs not covered by insurance. You designate a yearly amount to contribute to the FSA. Your employer deducts a prorated amount from each paycheck before taxes. Whenever you pay for an approved medical item, you draw down on your fund of pledged contributions, often with a dedicated debit card.

The account allows you to save money by purchasing health care-related items with pretax money, essentially giving you a big discount. The problem with FSAs is they are “use it or lose it.” You must use the FSA money by the end of the calendar year, though many employers extend the deadline into the following year. Otherwise, you forfeit the balance. FSA money was typically used to pay for medical co-pays, deductibles and prescriptions. In 2003, the IRS loosened rules on what you could buy with FSA money, allowing over-the-counter medications and medical supplies. The new rule essentially reverses part of the 2003 change.

However, over-the-counter medicines aren’t a big part of FSA spending, on average. Only 9 percent of FSA reimbursement claims, and only 3 percent of FSA dollars, are for purchases of over-the-counter drugs and medicines, according to CBIZ, a professional-services company that processes 46,000 FSA claims per month. So, there are still plenty of tax-free purchases to make with an FSA, and literally hundreds of dollars to be saved for many households.

“I hope people continue to use their FSAs. They just have to be a little bit careful about the amount of their contribution,” said Melissa Labant, a tax manager at the American Institute of CPAs.

* Re-evaluate. During open enrollment this year for your company benefits covering 2011, take a critical look at how much money you should commit to your FSA, said Philip Noftsinger, president of the payroll-business unit of CBIZ. Many plans have online sites that allow you to see previous FSA purchases, he said. How much did you spend in 2010 and 2009 on over-the-counter drugs and medicines? If it’s a big dollar amount, you might want to reduce your 2011 pledge to your FSA, but most people should be fine leaving the contribution the same, Noftsinger said.

* Stock up. Smart FSA users know to stock up on medicines and supplies to exhaust their FSA fund every year. This year, use FSA money to stock up on over-the-counter drugs and medicines before Jan. 1. For example, if it’s a choice between stocking up on over-the-counter medications or paying a bill for kids’ braces that could be paid after Jan. 1, choose the meds, said Rob Wilson, president of outsourcing firm Employco USA, in Westmont, Ill., which helps small businesses set up employee-benefit plans like FSAs.

Even if your employer’s plan includes a grace period for FSA spending that spills into 2011, Jan. 1 is still the deadline for using FSA money to buy over-the-counter meds, the IRS says. Don’t worry if you aren’t reimbursed before New Year’s Day. You just have to make the purchase in calendar year 2010.

* Get a script. A minor loophole or workaround in the new rule is that you can still buy over-the-counter medications if they’re prescribed by your doctor. So, the advice is to become less shy about asking doc to whip out his prescription pad. If during an exam he says, “give the toddler Children’s Tylenol,” make him write a script so you can buy it with FSA money.

“It doesn’t cost anything extra to ask for a prescription, and then you can use your FSA,” Labant said.

However, buying over-the-counter medicines with FSA money will be more of a hassle. You’ll have to submit for reimbursement not only the receipt but the prescription, too, according to IRS rules. That’s more complicated than simply buying aspirin with your FSA debit card, often called a flex card.

“You’re probably not going through that effort for medications you keep in your house for the occasional headache or sunburn,” Noftsinger said.

Another change with health FSAs is coming in 2013. That’s when the government puts a $2,500 cap on money you can squirrel away in a health FSA, or half of what many companies allow you to put in today. Nearly 20 percent of FSA participants pledge more than that, CBIZ said.

Translated prescriptions often wrong. Half of automated Spanish versions have errors, Study finds.

May 17, 2010 By: Nadia Category: HealthCare, Medicine Advice, Medtipster, Prescription News Source: Chicago Tribune, 5.12.2010 – Whitney Woodward, Alejandra Cancino and Julie Deardorff

Martha Jimenez was worried when the antibiotic she was giving her 8-year-old daughter, Linda, ran out a day early.

“I got scared,” said Jimenez, who usually sees a doctor who speaks Spanish but made an emergency appointment because her daughter had a fever and bad nosebleeds. Jimenez left the doctor’s office without really understanding how to administer the medicine, and relied on the directions the pharmacist attached. But they were confusing, and Jimenez couldn’t figure out the dosage, so she guessed.

A study released recently suggests that similar miscommunications are not uncommon. Pharmacies that print prescription labels translated into Spanish often issue inaccurate or confusing instructions that could be potentially hazardous to a patient’s health, according to a report in the May issue of Pediatrics journal.

Researchers looked at 76 medicine labels generated by 13 different computer programs that many pharmacies use to make translations and found an overall error rate of 50 percent.

“It’s not surprising, and it’s something I experience in practice every day,” said Dr. Alejandro Clavier, who works at Esperanza Health Center in Chicago’s Little Village neighborhood on the Southwest Side.

He gave an example of an anemic patient who showed no signs of improved iron levels after taking prescribed supplements. Clavier discovered the patient had been taking only one drop of the supplements instead of the amount that Clavier had prescribed. The patient had received confusing prescription instructions from the pharmacy.

Prescription information delivered in “Spanglish,” a mix of English and Spanish, is a frequent problem, according to the study. For example, instructions to take iron “once” a day would mean one time. But in Spanish, once means 11. It could be harmful for a patient to take 11 doses of iron a day, the study noted.

Misspellings also created errors. The study found that instead of the word boca, which means “mouth” in Spanish, poca, which means “little,” was used.

Other words and phrases — including “dropperfuls,” “take with food,” “apply topically,” “for 7 days” and “apply to affected areas” — were not translated into Spanish at all.

“It’s scary how high the error rate is,” said lead author Dr. Iman Sharif, chief of the division of general pediatrics at the Nemours/Alfred I. duPont Hospital for Children in Wilmington, Del. “If we can’t do this right in Spanish — the most commonly spoken non-English language in the U.S. — I’m afraid to think what happens with the other languages.”

Sharif’s report, which surveyed pharmacies in the Bronx, N.Y., goes hand-in-hand with the findings of a study last year from Northwestern University’s Feinberg School of Medicine. According to that study, many pharmacies in four states with large or rapidly growing Latino populations cannot provide prescription translations. That 2009 study also found that almost 35 percent of pharmacies surveyed did not offer translation services, and about 22 percent offered only limited translation services.

“It’s not that pharmacists are horrible people, it’s just that if they don’t speak the language … they don’t want to guess,” said Stacy Cooper Bailey, a clinical research associate at the Feinberg School of Medicine who was the lead researcher of the study. “They can’t do any spot checks for accuracy, so you can understand why there’d be some hesitancy there to do translations.”

During her research, one pharmacy employee said he would “run to the Mexican restaurant down the street” if a translation was needed, Bailey said. Others employed pharmacy staff members who had taken Spanish in high school, Bailey said.

The Alivio Medical Center in Chicago’s Pilsen neighborhood provides its 21,000 patients — the majority of whom speak Spanish — with services in Spanish and English. The center’s executive director, Carmen Velasquez, said using computers to translate important medical information is an inappropriate substitute for a human being.

“It’s health care. If you have the responsibility of human life, you better well know what you are doing and saying,” Velasquez said.

Sharif, the study’s author, said that one of the biggest problems is that English prescription instructions aren’t standardized. Because the same instructions can be written in multiple ways, the available databases can’t translate every word that doctors use to write prescription instructions, she said.

That’s why doctors and pharmacists must go over the instructions with patients and explain what they need to do, regardless of what language they speak, Sharif said.

That’s what Akil Ghoghawala does. The pharmacist manager of Bienestar Pharmacy, which operates inside the Alivio Medical Center, speaks five languages, including Spanish, and says he makes it a point to orally explain to patients how to take medications.

“It doesn’t only apply to someone who has a language barrier — it applies to everybody,” he said. But he has seen some bad translations, including ones that are verbatim. That leads to mistakes, he said.

“I override (the program), each and every time,” Ghoghawala said, adding that it is not a new problem.

Jimenez, 35, is thankful there was no serious injury to her daughter, but she still is not sure what went wrong. Back at Esperanza Health Center recently — this time for her 16-year-old son, Erick, who had a bad cough — she said she’ll make sure she understands the directions before she leaves the doctor’s office.

“If I don’t understand, I look for someone who speaks Spanish,” she said, or have her 14-year-old daughter translate.

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