I’ve never had to have a doctors note (nor written one for someone) to buy something that is already approved on the list. My understanding though is it should be something your “condition” needs. For example, I purchased a very expensive stethoscope with my funds and could do that because I have high blood pressure. For your, everyone has skin so go ahead and buy sunscreen.

Some times you do need physician letters but for items that specify you need it. For example, exercise equipment is on that list and I have written a letter saying I recommended exercise and had specific amounts of use per week for their condition as treatment. Even this could be applied to a number of conditions, from weight loss to depression to high blood pressure.

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Also, double check with your plan administrators about carryover. Under my employer's plan (this is employer specific), I am allowed to roll over a certain amount from 2022 to 2023 funds.

You only need a letter of medical necessity for certain items. You don't for sunscreen.