Do I Need a Doctor’s Prescription for My Purchase to be HSA/FSA Eligible?

Short Answer:
No – if you’re using a product as part of a medically necessary intervention, you generally do not need a doctor’s prescription. Instead, a Letter of Medical Necessity (LMN) is sufficient, provided it meets IRS guidelines.

Certain products do require a doctor’s prescription for HSA/FSA reimbursement, including:

• Pharmaceutical Drugs

• Durable Medical Equipment

For these items, a prescription is necessary to document medical necessity and ensure proper coverage.

For other health or well-being expenses used for medically necessary interventions, a doctor’s prescription is not required. Instead, you must provide a Letter of Medical Necessity (LMN) that includes the following:

• Clinical Rationale:
  The LMN must clearly explain how the product is “primarily for” the prevention or treatment of a specific condition.

• Diagnosis by a Qualified Provider:
  Your condition must be diagnosed by a healthcare provider who is qualified to make that determination.

• Prevention and Treatment:
  For preventive measures, the LMN must detail how the expense directly involves the immediate and proximate prevention of the condition.

These requirements ensure that your health purchase aligns with IRS guidance on eligible medical expenses—even if it isn’t explicitly listed in Publication 502.

Your LMN is issued by an independent healthcare provider who is licensed in your state and meets state-level telemedicine requirements. It:

• Demonstrates Medical Necessity:
  Clearly connects your diagnosed condition with the recommended use of the product.

• Meets IRS Guidelines:
  Shows that your purchase is “primarily for” the treatment or prevention of a condition, satisfying the criteria for HSA/FSA reimbursement.

Thus, if you have an LMN that includes these details, you do not need an additional doctor’s prescription for your claim.

If your HSA/FSA administrator is requiring a prescription despite your valid LMN, it may be an error or misclassification on their part. We recommend that you:

1. Alert Your Administrator:
   Inform them that, under IRS guidance, a valid LMN is sufficient for HSA/FSA reimbursement when it comes to health purchases for medically necessary interventions.

2. Appeal the Denied Claim:
   Ask that they review your claim using the correct guidance for your product or service type.

If you need further assistance, please contact Truemed support at support@truemed.com. We’re here to help ensure you receive the appropriate reimbursement for your eligible expenses.