Changes to FSA Eligible Products List & What They Mean For Pharmacy

Earlier this week, SIGIS members received a letter detailing changes to FSA, HSA and HRA product eligibility, resulting from the recently signed CARES act. In recent years, OTC medications have required a prescription to be eligible for purchase with a benefit card. The CARES act reverts product eligibility criteria  to an earlier model.

This means that the number of products in your pharmacy that a patient can use a health benefit card to purchase has vastly increased. And as the bill was signed into law with a retroactive effective date of 1/1/20, you may already have patients looking to have more of their purchases deducted from their FSA, HSA or HRA card.

So how do you get those products flagged to be eligible for benefit card purchase? How long will it take, and what do you need to do?

To answer those questions, here’s a bit of back ground on how this all works.

A majority of RMS customers participate in SIGIS programs under something known as an IIAS Certification. This certification requires that your point-of-sale system has completed their own set of SIGIS certifications with one or more credit card processors, proving that the POS system sends IIAS transaction data.

Basically, when you process a transaction on a certified POS system, under your own IIAS merchant certification, the POS can determine what products are eligible for purchase with an FSA card, and which ones aren’t. When a customer uses an FSA card, only the FSA eligible total is deducted from the card and appropriate flags get sent with the transaction essentially proving the eligibility of the purchase. It makes it easy for you and keeps your customers from having to submit receipts or requesting re-reimbursement.

The eligibility of a product is determined through the SIGIS eligible products list. This list is updated by SIGIS on a monthly basis and made available to members. For RMS customers, the list is imported through the point-of-sale system, and the products flagged as needed to make the purchase process function as designed. Setting items manually isn’t advisable as it could cause issues with card acceptance, should a transaction be called into question by a card issuer. As a SIGIS member and certified POS provider, we rely solely on the eligible products list to flag our customers product files.

Per the letter SIGIS sent out, they are working to process the changes mandated through the CARES act and anticipate that the Eligible Product List will be completed and released on 4/15/2020. This does leave a bit of lag time where customers may need to submit for reimbursement. We know that this is frustrating, but hope that a bit of explanation of what’s going on and why will help everyone stay on the same page.

If you’re not sure what to do about all these changes, our recommendation is to contact your point-of-sale provider for further information. RMS customers should have already received further information specific to our POS system from our support team, but if you haven’t, just let us know and we’re happy to advise further.