Claritin

[Guest motor]

Hey everyone,

I searched and seached for a specific answer on this and cannot find one. So I'm asking you.

I have someone submitting a receipt for Claritin to the cafeteria plan. Now that this is over the counter I say that I have to deny the claim.

BUT.....

On the other hand, I know the argument will be that there was a script and that the person was submitting it for, and receiving reimbursement.

What now? Are these people just cut off?

Any opinions out there?

TIA

[Guest JerseyGirl]

First, did they get the Claritin as a prescription from a pharmacy with the documentation to back it up, or did they buy the over the counter version? A prescription is a prescription, and if that's what the participant is claiming for reimbursement, I would approve it.

I'm guessing that this is a refill on an Rx written before Jan 1, 03, and when it runs out, the physician won't be re-writing since Claritin is no longer on the insurance co.'s formulary. At that point, the doctor can either switch them to another NSA such as Alegra, or advise the patient to go with the over the counter version.

[Guest motor]

Yeah, if this was filled at the pharmacy as a script, I would have no problem reimburseing this claim. This was a prescription. The prescription was valid at the time Claritin went OTC.

The argument is that the doctor did prescribe the Claritin. It's not the participant's fault that it went OTC.

Yeah, if this was filled at the pharmacy as a script, I would have no problem reimburseing this claim.

On one hand I look at it as being no different than Motrin, or something of the like. Of coarse I would reimburse for a script of Motrin but not the over the counter stuff, On the other hand Claritin, isn't even offered as a script anymore. Are these people with prescriptions for Claritin left out in the cold?

[Guest kwn]

We had the same problem when Zantec was taken off the prescription list.

During our enrollment period we comunicate to our participants:

Three tests to pass before it is eligible for reimbursement of medicines.

1. It must be prescribed by a licensed person to prescribe such a medicine.

2. It is prescribe for a medical condition

3. It is not something that can be bought or purchased over the counter.

Once a drug is taken off the list of prescription only and can now be bought over the counter it fails that test. We have sent a notice to our clients telling them that Claritin is no longer an eligible reimbursement. We would not reimburse.