medication flavoring

A TPA told an employer that charges for flavorings added to Rx medicines (usually for kids) are not reimbursable under an FSA. Has there been any IRS guidance on this issue? I can't find any. TIA. 

I suspect that there is no guidance on this interesting question. 

My gut says to permit reimbursement of these expenses but only if accompanied by documentation from a medical provider that the extra flavorings are recommended in order for the patient to take the medicine.  

If the flavorings are already added (e.g., by a pharmacist) before delivery to the patient, I feel even more strongly that it is reimbursable.  

The discussion was only about flavorings that are added by the pharmacist, but they are usually not "prescribed" by a doctor. 

Thanks. 

What would initiate the pharmacist to add the flavorings? 

If it was done in the ordinary course, I think it is almost certain that the IRS would permit reimbursement.  If it is done by request of the patient, that perhaps is a harder question but I still think it is reimbursable particularly if he or she could provide documentation that his or her provider recommended that they be added.

My 2 cents is that the additional cost associated with adding flavor is not deductible.  The addition of a flavor, and it's associated cost, is because the patient does not like the flavor of the drug.  I see it as a non-medical ingredient and should not be allowed as an eligible expense.  What would be next?  If I do not like the taste of a certain drug, can I deduct the cost of a shot of whiskey I use to mask the flavor?

1 hour ago, Chaz said:

What would initiate the pharmacist to add the flavorings? 

If it was done in the ordinary course, I think it is almost certain that the IRS would permit reimbursement.  If it is done by request of the patient, that perhaps is a harder question but I still think it is reimbursable particularly if he or she could provide documentation that his or her provider recommended that they be added.

The pharmacist usually adds it to specific types of liquid medications for children. Amoxicillin is a good example. It makes the medicine much more palatable and easier to get the kids to take them. Sometimes, the pharmacist will ask the parent what flavor to add (in other words, the pharmacist knows that it is a particularly yucky medicine); other times the parent can just ask for it. I do not know if the cost gets itemized separately on a receipt or if they just add it to the cost of the medicine so that there is one total. My guess is that you will find pharmacies that do it both ways. 

While there is no specific therapeutic benefit to the flavor, there is also no use other than for prescription medication (unlike the leevena's whiskey example).

Just out of curiosity - what would a "normal" charge be (if any) to add flavoring, if it is a separate itemized fee?

Follow Up Note:

Publication 502 defines a "prescribed drug" as "one that requires a prescription by a doctor for its use by an individual." It seems like the flavoring could fit under here, as it is only available as part of a prescription. 

Certainly not definitive, but at least one major TPA lists this as an eligible FSA expense:

https://www.payflex.com/en/employers-brokers/products-programs-health-care-fsa.html

Brian, never would I have thought this would be allowed as an eligible expense.  Thanks for posting.

Note that if a plan sponsor is hesitant about reimbursing this or any other expense, it can always exclude it as long as the plan and SPD accurately reflect that exclusion.