When to Count Nonprescription Drugs toward the Medical Expense Allowance
By Daniel Bagliore
When the head-of-household, spouse, or co-head is elderly (62 years of age or older) and/or disabled, the household is eligible for a medical expense allowance. When the household is eligible for the medical expense allowance, the out-of-pocket, unreimbursed expenses of all household members (except live-in aides) are included in the medical expense calculation.
Exhibit 5-3 of HUD Handbook 4350.3 identifies various allowable medical expenses, which include, among other things, prescription and nonprescription drugs.
Prescription drugs are dispensed by a pharmacy with a prescription from a health care provider. Prescription drugs may include such medications as opioids, depressants, antidepressants, stimulants, antibiotics, drugs prescribed to quit smoking, birth control, and Viagra. The purpose of the prescribed drug is irrelevant for its inclusion in the medical expense calculation.
Nonprescription drugs, on the other hand, do not require a prescription and can be purchased over-the-counter at a pharmacy, department store, or other retail outlet. Nonprescription drugs may include cold and allergy medications, antihistamines, pain/fever reducers, nutritional and herbal supplements, vitamins, and natural medicines.
When to Include Nonprescription Drugs
Nonprescription drug costs may be included in the medical expense calculation when:
- Recommended in writing by a medical practitioner in the practicing locality; and
- The nonprescription drug is necessary to treat a specific medical condition.
A nonprescription drug intended to prevent a medical condition or promote good health is excluded from the medical expense calculation even when recommended in writing by a medical practitioner.
Let’s use the following example to differentiate between the two concepts:
Example: A resident requests that her out-of-pocket, unreimbursed costs for calcium supplements recommended by her doctor be included in the medical expense allowance. Inclusion of this expense depends on whether the doctor recommended the calcium supplements to treat a specific medical condition or merely to prevent medical conditions or promote the resident's ordinary good health.
Should the doctor have diagnosed the resident as having a medical condition, such as osteoporosis, and recommended that she take nonprescription calcium supplements daily to treat this specific medical condition, then count the cost of the supplements toward her medical expense calculation.
However, if the doctor recommended that the resident take the calcium supplements not to treat a specific medical condition, but rather to prevent a condition such as osteoporosis or to maintain the health of her bones, then the supplements are for “ordinary good health,” and the cost must be excluded from the medical expense calculation.
Therefore, when a tenant requests the inclusion of nonprescription drug costs in the medical expense calculation, you will need to verify with an appropriate health care provider that the nonprescription drug is recommended to treat a specific medical condition (without requesting the medical diagnosis); should you verify that the nonprescription drug is recommended merely to prevent a medical condition or maintain good health, the costs must be excluded from the medical expense calculation.