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May 21, 2018

Is Your Pharmacy Tattling on You to Your Doctor?

Filed under: Health,Internet,Retail — Edgar (aka MrConsumer) @ 6:18 am

This week’s story questions whether a druggist who believes that a patient is not taking their prescription should squeal on them directly to their doctor.

A couple of weeks ago, MrConsumer got an unexpected letter from his primary care physician (PCP). It said:

Letter from doctor


Say what? My mail order pharmacy, CVS/Caremark, wrote to my PCP to tell her I might not be taking my medications properly, urging her to be in touch with me (hence she sent the letter above).

Here is the fax they sent her:

CVS Caremark fax

Apparently, this is what happened. For years, I have been taking simvastatin to help lower cholesterol. I get 90-day prescriptions filled via mail order from Caremark, and the last time I ordered it was January 15th. Sometime shortly after April 15th, when I had not yet reordered it from them, CVS/Caremark took it upon themselves to notify my doctor. In turn, she sent me the above letter expressing concern.

No, MrConsumer is not having a problem taking the drug daily. He simply had several weeks of pills left over since prior prescriptions were received in advance of them actually being needed. We have all experienced the practice of pharmacies telling us way in advance that it is time for a refill when we still have plenty of pills left from the last one.

On one hand, maybe Caremark should be thanked for putting the patient’s health ahead of privacy concerns. But on the other hand, it feels like the company was overreaching, going behind the back of the patient to his PCP to tattle on him, without asking the patient first if he was having a problem. Of course, they did send me refill reminders.

A quick review of CVS/Caremark’s terms and conditions and privacy policy on its website did not reveal any specific disclosure that such contacts would be made. However, in its HIPAA policy, it made this broad disclosure:

*MOUSE PRINT:

Uses and Disclosures of Your PHI for Treatment, Payment and Health Care Operations

We may use and disclose your PHI for treatment, payment and health care operations without your written authorization.

PHI is information about you that we obtain to provide our services to you and that can be used to identify you. It includes your name and contact information, as well as information about your health, medical conditions and prescriptions. It may relate to your past, present or future physical or mental health or condition, the provision or health care products and services to you, or payment for such products or services. [Definition inserted to guide readers.]

The following categories describe and provide some examples of the different ways that may use and disclose your PHI for these purposes:

Treatment: We may use and disclose your PHI to provide and coordinate the treatment, medication and services you receive. For example, we may:

Use and disclose your PHI to provide and coordinate the treatment, medication and services you receive at CVS Health. Disclose your PHI to other third parties, such as pharmacies, doctors, hospitals, or other health care providers to assist them in providing care to you or for care coordination. In some instances, uses and disclosures of your PHI for these purposes may be made through a Health Information Exchange or similar shared system. Contact you to provide treatment-related services, such as refill reminders, adherence communications, or treatment alternatives (e.g., available generic products). [Emphasis added.]

This says that your personal health information, including your prescriptions, can be disclosed to third parties, such as doctors, to assist them in providing care to you. However, it says Caremark may contact YOU, the patient, with “adherence communications.” It doesn’t explicitly say, however, that they can contact your doctor with respect to your staying on your regimen.

Mouse Print* contacted CVS/Caremark to get an explanation of their practice of contacting doctors to report patients who may not be adhering to their prescriptions. Here are excerpts from their response:

Taking medications as prescribed is one of the most important things patients can do to get and stay on their path to better health. Non-adherence to prescribed therapies comes at a significant cost to patients’ health and finances, as well as to the entire health system.

One of the ways we encourage adherence is through our clinical program that reviews members’ prescription refill behavior for maintenance medications, including drugs prescribed to help manage a patient’s cholesterol. Through this program, we send refill reminders and late-to-fill outreach to plan members and engage prescribers when members are past due for refills.

Our adherence outreach program is consistent with HIPAA and our own privacy policy… -Mike DeAngelis, Senior Director, Corporate Communications

I really have mixed feeling about this, as expressed above. What do you think? Do you want your druggist to notify your doctor when you don’t get a timely refill of a maintenance drug?

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23 Comments

  1. I only want them to notify my Doctor if she and I have agreed on this beforehand. If I was having memory problems for instance.

    Comment by Gram — May 21, 2018 @ 7:19 am
  2. Plain and simple, CVS does this to generate increased revenue. They should have called Mr. Consumer, not the physician. CVS tries to frame itself as a healthcare company, but they care little about patients. Read this eye-opening story about CVS.

    http://epaper.bostonglobe.com/BostonGlobe/article_popover.aspx?guid=901413f6-48dd-40c1-aa7a-ec7fae62f1fe&source=next

    Comment by HMC — May 21, 2018 @ 7:32 am
  3. Knowing how money-hungry Big Pharma is, this feels to me like a slightly underhanded way to make sure they get your money regularly. I’d be less leery of their motive if they had more of a history about caring for people more than profits.

    Comment by Sunny Humphries — May 21, 2018 @ 7:44 am
  4. That notice to MR CONSUMER must have been quite a surprise. Not many people read the entire HIPAA statement let alone the notices we agree to in any circumstance. I agree that notice/call to the consumer first would have been better than notice to the doctor. Too big brotherish!

    Comment by Rosemarie lauria — May 21, 2018 @ 8:03 am
  5. Outrageous! Just a ploy to keep big pharma’s coffers filled. If I want to stop taking a medication that’s my business. I’ll discuss it with my doctors when I see her.

    Comment by Nancy Savageau — May 21, 2018 @ 8:09 am
  6. Although It may seem a bit “1984”,I have to agree the pharmacy.Having been in the medical field for over 20 years,we can only do so much to make the patient aware of his medical needs.Look at from their perspective,if you were to be hospitalized or worse die,and it became aware that the pharmacy was not doing its job,they become a plaintiff in a lawsuit.
    Is this what you want?

    Comment by Dave — May 21, 2018 @ 8:29 am
  7. Third parties? Hmmmm. Maybe a nice fishing expedition to another drug company? Naw…can’t happen. Next someone will try to tell me that doctors sell out to pharmaceutical companies for their own enrichment. Corporations with a responsibility to your health would NEVER do that.

    I have CVS and had a medicine prescribed for a chest cold. It had one refill allowed, but the cold cleared up. Then I got a call about the refill. Like, MC, I have some real mixed emotions.

    Comment by Rick M. — May 21, 2018 @ 8:36 am
  8. You said that you reordered the medication about Jan. 15, but CVS’s fax to your doctor was dated April 11, not even 90 days after the order. Seems to me that they jumped the gun.

    yes, I get the calls and texts from CVS (local store, not mail order) reminding me that one or more prescriptions are due for refill. They are usually when I have maybe two weeks left on a 90 day refill. Sometimes I’ll agree with them and order the refill, sometimes not.

    That I am aware of, I have never been reported to my doctor.

    Not knowing your prescription drug plan, but just put it on automatic refill. I’m on a Medicare Advantage plan that provides a number of $0 co-pays, so that doesn’t bother me.

    Don’t forget that you can ask the pharmacist for the non-insurance cost of the drug. Many times the co-pay is higher than the price for the generic medication. As I understand it, the pharmacist is not allowed (or required) to suggest the non-insurance cost.

    Edgar replies: The fax in the story is a copy that CVS/Caremark provided to me, as the original was discarded. So the MAY 11 date (not April 11) was when it was reprinted.

    Also, Medicare does not allow auto refills (at least in my plan).

    Comment by bobl — May 21, 2018 @ 9:38 am
  9. The idea seems helpful, but in practice they jumped the gun. It seems like they are only trying to ensure they get paid, never mind the unexpected tattling plus the extra junk fax that your doctor has to handle. If I were a doctor, unnecessary faxes like that would make me crazy.

    Comment by Shawn — May 21, 2018 @ 10:10 am
  10. Not surprised at all. Caremark fills my in box with those refill notices way too often. My husband’s meds change often. Even when I called because I couldn’t remove some RX listings online, I didn’t get any help. The customer service gal told me she can’t remove it from the list either. So we get notices about the same drug he hasn’t taken in four years.

    Comment by Gayle — May 21, 2018 @ 10:23 am
  11. I work in the infectious disease field. Too many times I have seen persons not stay on their meds. We have signed legal agreements with pharmacies to call the Medical Case Manager if a client has not picked up their medications. In the world of inflating health care costs, there is a huge need for adherence to medications. Imagine how much it would cost if you found out you had a blockage due to not taking your statin in a timely manner. I understand you say the issue is the refills are happening too early. Please discuss the refill issue with the pharmacy to arrange a better schedule. One thing we hate is getting calls from the hospital from someone who wasn’t adherent to their meds. The body can only recover so many times before it wears out.

    Comment by n1tootsie — May 21, 2018 @ 10:23 am
  12. I see no problem with CVS pharmacy contacting your PCP. No privacy was breached according to HIPPA. Why get all bent out of shape about the effort to keep you taking your medicine. Maybe it wasn’t needed in your case, but many people DO stop taking their medications for the reasons CVS mentioned. I think it is very HELPFUL for CVS to monitor their clients refills and non-refills. There are so many other things to be concerned about. In my mind – this is NOT one of them.

    Comment by CBS1 — May 21, 2018 @ 12:28 pm
  13. CVS in our Target store bought out the Kmart prescriptions so I was shuttled to them, and I’m not happy at all. They call all the time, morning, noon, night, twice a day, every day, and they want me to reorder or come and get a prescription they have for me, which I did not request. I spoke to the pharmacist who assured me he would end the calls, but sadly, he did not. I take several medications so they probably treble the calls for all of them. I see the doctor every six months, and sometimes I have leftover pills before he renews the Rx, so it’s really confusing to get all those calls. CVS does not want you to manage your own prescriptions (they are a PROFIT-MAKING company!).

    Comment by MerryMarjie — May 21, 2018 @ 1:24 pm
  14. Just a quick question Mr. Dworsky. You say you have been taking simvastatin for years, it doesn’t seem to be working if you have been taking it for years. Shouldn’t you have seen some improvement by now? If not why hasn’t your doctor switched you to something else?

    Edgar replies: I don’t particularly want to get into my personal medical issues here, but this drug is not meant as a “cure” for high cholesterol — it controls it by bringing it down. And just the way if a diabetic stops taking insulin, his/her blood sugar will rise, the same is true in my case.

    Comment by Becci Boyd — May 21, 2018 @ 1:50 pm
  15. I want to retain my right to manage my health the way I want. I do not need the doctor or company to manage my health. I do not care if I take meds or not as long as I do not harm myself or others. This doesn’t give them the right to look up and see if I take them or not. This is scary!

    Comment by James — May 21, 2018 @ 2:22 pm
  16. As a medical professional I manage my own and my wife’s medical care. I do not appreciate having someone else decide how our care is, or is not, delivered. On another issue, I also do not appreciate medical offices attempting to “force” us as patients into deciding which pharmacy is going to receive any prescriptions electronically. I want the Rx printed out and handed to us, so that we can shop for the best price. Everything in the medical system is geared to making sure hospitals and pharma make more money. It has little to do with patient care or controlling costs.

    Comment by David Schurgin — May 21, 2018 @ 5:36 pm
  17. I definitely do not like this. What I do or do not take is entirely down to me. There is no law that forces you have treatment (as long as you are not a danger to others of course), I do not want a company looking over my shoulder.

    I have several different prescriptions for statins at the moment, as my doctor and I try to find the best one for the side-effects that I am having. I certainly will NEVER use CVS again, because I am going to have them faxing my doctor because I’m not taking all of the statins that have been prescribed to me in the past month. Of course I’m not refilling several prescriptions, because we changed the medication to a different one.

    They go far beyond what is acceptable for personal liberty. If you work for them, you know you get a financial penalty if you do not give up smoking, or lose the weight they want you to? (http://www.nydailynews.com/life-style/health/short-cvs-employees-forced-report-body-weight-quit-smoking-pay-article-1.1294421)

    They have just lost another customer…

    Comment by Terry — May 21, 2018 @ 9:25 pm
  18. Walgreens also does this. In February I was put on a statin by my new doctor. I didn’t take to it well – it seemed to cause a much more important medication to stop working – so, after contacting my doctor’s assistant, I stopped taking it. I got a bunch of reminders from Walgreens about refilling my script, which I obviously ignored. Then I got an e-mail from my doctor, who had been contacted by them. I hadn’t seen her for a follow-up yet, so she had forgotten about me stopping it. I was floored by the incessant reminders and then tattling to my doctor over a medication I’d only filled once!

    Comment by Sarah — May 21, 2018 @ 10:15 pm
  19. It’s all about Medicare’s Star ratings. Better patient adherence numbers equals a higher star rating & better reimbursement. Primary focus is on cholesterol, diabetic & blood pressure medication adherence & on therapeutic regimens (ie which bp med a diabetic is on or whether or not a statin should be prescribed based on the patient’s other medications.)

    Comment by Sue — May 22, 2018 @ 7:40 am
  20. I also am on a Medicare Advantage plan and use CVS. I use CVS Multidose that packages all my meds into daily packs. It is processed through a CVS retail location, however. I get a monthly call to ensure there have been no changes prior to a new box being sent. Many phone calls and notifications seem to enabled by default for new patients but can usually be turned off on the website or by asking not to be called. The CVS mail order site allows you to select what motivations you receive.

    While I agree the fax sent to the doctor might seem like a greedy overreach I believe it’s also important to remember that your pharmacist was always meant to be a part of your “care team”. We have become used to a system where the information flow was one way – towards the pharmacy. Now we have the technical and legal ability for bi-directional data flow. That can kinda seem like an invasion of privacy but it really should have been there all along.

    We might not be able to control whether or not our pharmacist tells our doctors about our medication purchase patterns. The phone calls and emails can, however, be managed in most cases.

    Comment by James Hill — May 22, 2018 @ 8:21 am
  21. ABSOLUTELY a good thing. Yes, Caremark CVS make $$ by ensuring consumption of pharmaceutical. But people need to get off their high horse and be grateful that different facets of the medical industry are interacting with the end result being potentially a life-saving (or quality of life improvement) action because a patient forgets or refuses or has a problem taking the meds. Worst-case, there’s a legit reason and it gets explained, and end of story. People will whine and bitch forever about the abysmal state of medical care in the US, but one whiff of improvement and innovation sends everyone into a holier-than-thou manifesto about “invasion of privacy”. Plenty of other things to legitimately complain about. This isn’t one of them !!!

    Comment by Jim K — May 24, 2018 @ 10:57 pm
  22. hot a call from walmart tge other day. telling me it was time to refill a perscription i just filled last week. i have to refill onthly as Connecticare will not allow me to get a 9” day supply.

    the perscription cost … my out of povket without any payment from ins co…$4 a month. last year i was going out of country for a few mo ths and ins co put me through the ringer for a 3 month refill. i pay these fools $930 a month and they want to fight over $8.

    thats when i paid gor it myself and found out the ins co was actually not paying anything at all.
    my coosy is actually the full price. what a scam !

    Comment by rich — May 28, 2018 @ 6:20 pm
  23. I understand that from the perspective of CVS, it seems like they “care”, but the fact that they did not first try and contact the patient irks me.

    What if Mr Consumer decided to purchase prescriptions from a different company? What if Mr. Consumer chose another doctor?

    What CVS did was not appropriate. I sense that their main motivation is money, not patient care.

    Comment by Lerkero — May 29, 2018 @ 9:18 pm

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