Yes. You can use your HSA card for over-the-counter medicine without a prescription. A 2020 change in federal law made non-prescription drugs and menstrual care products qualified medical expenses for Health Savings Accounts, so pain relievers, cold and allergy medicine, antacids, first-aid supplies, tampons, and similar items can come out of your HSA tax-free.1Internal Revenue Service. IRS Outlines Changes to Health Care Spending Available Under CARES Act
Before the CARES Act, OTC drugs required a doctor’s prescription to be paid for from an HSA. That requirement is gone for any amount paid after December 31, 2019, and the change is permanent.1Internal Revenue Service. IRS Outlines Changes to Health Care Spending Available Under CARES Act
What You Can Buy
The eligible list is broader than most people realize. Anything the IRS treats as medicine qualifies, along with supplies that treat or prevent a health condition. Common categories:
- Pain relievers such as ibuprofen, acetaminophen, aspirin, and naproxen
- Cold, flu, and cough treatments, including syrups, lozenges, decongestants, and chest rubs
- Allergy medications, antihistamines, nasal sprays, and allergy eye drops
- Digestive aids like antacids, anti-diarrheal tablets, and laxatives
- First-aid supplies: bandages, antiseptic ointments, gauze, thermometers
- Menstrual care products, including tampons, pads, liners, and cups
- Skin treatments such as hydrocortisone cream, acne medications, and anti-itch creams
- Sunscreen with SPF 15 or higher and broad-spectrum protection
Pregnancy test kits, condoms, and breast pumps also qualify.2Internal Revenue Service. Publication 502, Medical and Dental Expenses Menstrual care products are specifically named in IRS guidance as treated like medical care for HSA purposes.3Internal Revenue Service. Publication 969 (2025), Health Savings Accounts and Other Tax-Favored Health Plans
What Looks Eligible but Isn’t
The IRS separates products that treat or prevent a medical condition from those that just support general health or hygiene. These common drugstore items do not qualify:
- Toiletries: toothpaste, shampoo, deodorant, soap, mouthwash
- Cosmetics, nail polish, and moisturizers marketed for beauty rather than treatment
- Daily multivitamins taken for general wellness
- Protein powders, workout supplements, and weight-gain products
Vitamins and supplements are a gray area. A daily multivitamin for general wellness is not eligible, but prenatal vitamins are, because they address a specific medical need. Glucosamine recommended for osteoarthritis can qualify on the same reasoning. The test is whether a healthcare provider recommended the supplement to treat a diagnosed condition. If so, you may need a Letter of Medical Necessity from your doctor identifying the condition, the product, and how long you should take it. Ask your HSA administrator whether they want that letter before or after the purchase.
How the Card Works at Checkout
Large pharmacies and retailers use an Inventory Information Approval System that checks every item in your cart against a database of eligible products, maintained under standards set by a group called SIGIS. When it works, the register approves your HSA card for the qualifying items and asks for a second form of payment for anything else in the cart, like groceries. The split is automatic.
Smaller retailers that do not use this system may decline your HSA card entirely, even for eligible items. Pay out of pocket and reimburse yourself from the HSA later. That reimbursement is still tax-free as long as you keep the receipt.
Online, many retailers tag qualifying products with an “FSA/HSA eligible” badge and let you filter search results. At checkout, the system applies your HSA card only to eligible items. Before you shop anywhere, confirm your card is active and check your balance.
You Can Reimburse Yourself Later
There is no federal deadline for reimbursing yourself. Buy eligible OTC medicine on a personal card today and you can withdraw that amount from your HSA tax-free next month, next year, or a decade later. The only rule is that the expense has to have been incurred after your HSA was established. An expense from before you opened the account never qualifies, no matter how long you wait.3Internal Revenue Service. Publication 969 (2025), Health Savings Accounts and Other Tax-Favored Health Plans
Some people use this strategically, paying medical costs out of pocket while the HSA balance grows, then reimbursing themselves years later. To do it, you have to save every original receipt.
Receipts and Form 8889
The IRS expects records that prove each distribution went toward a qualified medical expense and that you did not also claim the expense as an itemized deduction. Save a receipt for each purchase showing the date, retailer, product, and amount. A pharmacy receipt that only reads “merchandise” is not enough; you need the product name. A photo in a dedicated folder is fine. Tax records normally need to be kept for three years from filing, but since HSA reimbursements have no time limit, hold onto medical receipts indefinitely if there is any chance you will reimburse yourself later.
HSA activity gets reported on IRS Form 8889 with your federal return. If a distribution was not used for a qualified expense, the amount is added to your taxable income and hit with an additional 20 percent tax. That penalty is waived if you are 65 or older, disabled, or the distribution followed the account holder’s death.4Internal Revenue Service. Instructions for Form 8889 (2025)
A Note for California and New Jersey Residents
Federal law treats HSA contributions as pre-tax and lets qualified distributions pass through untaxed. Most states follow that treatment. California and New Jersey do not. In those states, HSA contributions are included in state taxable income and investment growth inside the account is taxable at the state level. Your OTC purchases are still federally tax-free through the HSA; you just do not get the parallel state tax benefit.