Tag Archives: medical

It Could Happen to You — A Call to Arms

On August 1, I wrote about how Big Brother may not be just the government, but, surprisingly, also your friendly pharmacist.  The Business Week article that I was referring to (http://www.businessweek.com/magazine/content/08_31/b4094000643943.htm) talked about how someone can be turned down for health insurance because the pharmacies they’ve used in the past have sent their pharmacy information to Pharmacy Benefit Managers (PBMs), who in turn sell the information to third parties, who sell the information to health insurance companies, who then deny health coverage. 

Sweet, huh?  For the health insurance companies, anyway.  But not for you.  Or your family.

And the road from the pharmacy to the PBM to the third party is all done without your authorization.  Which seems kind of funny to me, because pharmacies are HIPAA “covered entities”, and they need to have your authorization to share your protected health information, except in very specific circumstances.

Now, the HIPAA Privacy Rules allow an entity called a “Business Associate” to do business with a covered entity such as a pharmacy.  In such cases, the pharmacy, as the covered entity, must execute what’s called a “Business Associate Agreement” with the business associate, and part of the agreement allows the covered entity to share identifiable protected health information so that the business associate can do all kinds of things, under contract, to the covered entity — in this case, the pharmacy.

Okay.  So far we have a covered entity, the pharmacy.  And we have a business associate of the pharmacy, the PBM, pharmacy benefit manager.  Why would the pharmacy contract with a PBM? 

Because PBMs do all kinds of useful things that they can probably do a lot less expensively than the pharmacy.  Wikipedia says this about PBMs: PBMs are “. . . third party administrator(s) of prescription drug programs. They are primarily responsible for processing and paying prescription drug claims. They also are responsible for developing and maintaining the formulary, contracting with pharmacies, and negotiating discounts and rebates with drug manufacturers.  Due to their larger purchasing pool for prescription drugs, PBMs can negotiate rebates and discounts on behalf of their clients.”

I think we can agree that PBMs provide very useful services to pharmacies, right?  Good.

The problem comes along when the PBM sells your identified protected health information to yet a third party, for a profit.

I have a problem with that, a huge problem. 

The HIPAA Privacy Rules don’t allow your identifiable protected health information to be sold without your authorization. 

When was the last time your pharmacy asked your permission to sell your protected health information, or the protected health information of your children?  Gosh, I don’t remember ever being asked by a pharmacy to do such a thing with my protected health information. . . 

So I’m asking for your support: I’d like you to send an email to Health & Human Services and ask them the following questions:

1.  Is a pharmacy a HIPAA covered entity?

2.  Is a Pharmacy Benefit Manager a business associate of a pharmacy?

3.  Can a business associate of a HIPAA-covered entity sell identifiable protected health information to a third party — for a profit — without the patient’s authorization?

Folks, the FTC has looked into this and not seen a problem with the practice of PBMs selling your identifiable protected health information.  But they are not responsible for the HIPAA Privacy Rules, Health & Human Services is.

So, please — send an email to OCRPrivacy@hhs.gov and ask them the above questions.  The more people who ask, the more they’ll pay attention and look at this very serious problem.

If you think this couldn’t really be an important issue, then I’d like to introduce you to Mr. Walter Shelton and his wife, Paula, who were denied health insurance because pharmacies they’d used in the past — WalMart and Randall’s (part of Safeway) — sent their identifiable protected health information to a PBM, who, without their authorization, sold it to a company called Med Point.  Med Point put together a pharmacy profile on them and sold it, along with the Shelton’s names, for $15 to Humana.  And then Humana rejected their insurance application because of the use of a couple of very minor medications that many of us may need to use at one time or other.

Have Humana?  How about Aetna?  Blue Cross/Blue Shield?  UnitedHealth Group?  Some other health insurance?  Do you ever get your prescriptions filled at WalMart?  Safeway?  Randalls?  Then yes, it COULD happen to you, when they sell information about you to Med Point or their competitor, IntelliScript, for just $15.

Please everyone, a quick email to OCRPrivacy@hhs.gov — remember, it’s Health & Human Services (HHS) that administers the federal medical privacy laws and rules — and ask them:

1.  Is a pharmacy a HIPAA covered entity?

2.  Is a Pharmacy Benefit Manager a business associate of a pharmacy?

3.  Can a business associate of a HIPAA-covered entity sell identifiable protected health information to a third party — for a profit — without the patient’s authorization?

Mr. Shelton has already sent his email to HHS, will you send one, too?  Just takes a minute.

THANK YOU!!!

I blog regularly on medical privacy issues, medical records, HIPAA, and other related issues.  If you have any questions about your medical privacy, your ability to get copies of your medical records, privacy problems with your doctors, dentists, chiropractors, psychologists, etc., please send me an email at hipaadiva@yahoo.com — I would be honored to help.

Betcha Thought Big Brother Was the Gov’t — But You Thought Wrong

It turns out that a bigger threat to your privacy may not be the government (though they should certainly be high on the list).  Believe it or not, the bigger threat may be the remarkably potent combo of your health insurance company and your pharmacy.

What??  Your little ol’ pharmacy down at your grocery store, or your local drugstore? 

Yes, indeed, the very ones.

Turns out that the companies operating those pharmacies in your grocery store or drugstore often sell your prescription information to third parties called Pharmacy Benefit Managers. 

The Pharmacy Benefit Managers in turn sell your prescription information to two other companies: MedPoint and Intelliscript.

Here’s how it works: you apply for health coverage with any of a number of insurance companies, including Blue Cross/Blue Shield, Humana, UnitedHealth Group, Aetna, and others.  Generally you sign a release giving your authorization for the insurance company to obtain your previous medical history. 

Then, for a measly $15 a pop, MedPoint and/or Intelliscript sell your pharmaceutical “profile” to health insurance companies.

Here’s the problem: you may have signed a release for the insuance company to obtain your medical history, but you never gave your authorization for your pharmacy to sell your protected health information to MedPoint or IntelliScript.

Your pharmacy profile includes all the medications you’ve taken, along with a sweet little number that clues the insurance company on how much they might have to pay out on you in the future.

Taking anything “off-label”?  Problem.  Taking any mental health meds ?  Oops.  You might very easily be denied coverage.

Those who are particularly vulnerable are those who are self-insured, but even those trying to obtain insurance through their employers can be denied.

For the whole story, read the following: http://www.businessweek.com/magazine/content/08_31/b4094000643943.htm

Then, contact your Congressional Representative and your state’s Senators.  (I know, I know, but it’s a start.)  You can also file a privacy complaint with Health & Human Services.

Got a problem with the privacy of your health information?  Yes?  Did you read and understand the Notice of Privacy Practices your new provider gave you?  No?  Want more information about how to protect your health information?  Leave a comment, or send me an email at hipaadiva@yahoo.com.  And hey, tell your friends about this blog — bet they could use some help with their health privacy, too.