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:

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:

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?

Tropicana is known for its pure juices, many not made from concentrate. Now they are coming out with a new product line called Tropicana Kids, which was just announced via a press release.

Looking at the front of the product label reveals that it is organic, which certainly implies to many that this is a healthy choice. And their senior vice president touts the product, saying:

“We’re thrilled to launch Tropicana Kids, offering an organic, premium fruit juice drink for busy parents who don’t want to sacrifice their kids’ nutrition, …”

Indeed, the words “real juice” appear on the front of the label, but it is hard to read the smaller type above it.

*MOUSE PRINT:

It says “Sweetened with real juice.”

Huh? That is an odd expression for what one might assume is a juice product to start with.

*MOUSE PRINT:

There’s the answer! The first ingredient in this juice drink is water! And their press release announcing the product offers what might be a surprising explanation to many :

Tropicana Kids is an all-new line of certified USDA Organic premium fruit juice drinks offering delicious taste for kids with nutrition parents expect. Available in three flavors—Fruit Punch, Mixed Berry and Watermelon—Tropicana Kids is made with 45% real fruit juice and mixed with filtered water, with no added sweeteners, no artificial flavors and is an excellent source of vitamin C. Plus, the packaging features a clear panel so moms and dads can see the goodness inside, and feel good about serving Tropicana Kids to their children. [Emphasis added]

While it is a big plus that there is no added sugar or corn syrup, we’re not so sure that grossly diluted juice is a better nutritional choice for parents to make for their kids than 100% juice.

And certainly, the real nature of this product is not obvious from looking at the front of the package, peekaboo window or not, because parents can’t readily “see the goodness inside” just by visual inspection.

Did you see the Weight Watchers commercial last month that promised to pay people $100 to lose weight? Really? What’s the catch?

*MOUSE PRINT:

The $100 offer stays on the screen for exactly two seconds at the end of the commercial. In that time, never mind trying to read the mouse print, you can’t even read the large print, which says to qualify you have to lose 10 pounds in three months and that a purchase is necessary.

The reasonable consumer might therefore believe you have to buy a membership for at least three months, and then you qualify for the money back. Not so. You actually have to remain a member and pay membership fees for six months — twice was long as what some might have expected.

So how much do you have to pay to get back $100? The company has several membership plans, and the pricing varies by region. In Boston, the online only membership plan works out to $3.07 a week (or $79.82 for six months); the in-person meetings plan is $6.92 a week ($179.92 total), and the “coaching” plan is $12.69 ($329.94 total). [Note: These plans incorporate a discount because they are being purchased on a multi-month plan.]

So if you pick the online only plan, they literally will be paying you to lose weight because you will come out ahead by $20. For the other plans, the $100 rebate is a significant reduction from the regular price.

Other than potentially leading consumers to believe they could quit after three months, Weight Watchers seems to be doing exactly what they promise. How novel!

But not so fast. We asked their PR folks to confirm that a member choosing the $79 plan will in fact get back $100. We got no reply. Twice.

Our friends at TruthinAdvertising.org discovered an interesting fine print issue that we want to share with you.

There are many “health” bars on the market that frankly look like glorified candy bars except they are made with healthier ingredients. On such product is called RXBAR:

They came up with a brilliant marketing gimmick to put a big and bold ingredients list on the front of each package to convey its contents. Their slogan is, “We tell you what’s on the inside on the outside.”

Shoppers may well grab this bar or one of the other varieties thinking that the four or five ingredients shown are the sum total of the contents.

*MOUSE PRINT:

The ingredients panel on the back of the package lists all the ingredients in the actual order of predominance:

Dates, Peanuts, Egg Whites, Natural Flavor, Sea Salt.

While the number of missing ingredients was minor for this flavor, the other bars that the company sells can have up to nine total ingredients while only four are shown on the front.

Even their television ad seems to acknowledge that prospective purchasers could be misled by the ingredients list on the face of the package because they inconspicuously make the following disclosure at the end of the commercial:

*MOUSE PRINT:

A company spokesperson told TruthinAdvertising:

“We do not claim that the front of the packaging represents all ingredients in the product.”

What do you think? Are the RXBAR packages potentially misleading?

Once again it is open enrollment time for those choosing a new health insurance plan. In searching around for a new plan for MrConsumer’s friend in New York City, he came up with what looked like a dream plan — a new national plan that tapped into Cigna’s national network of 500,000 providers. (Most individual plans in New York have very limited networks except for Empire Blue — and even Empire is not all-inclusive.)

The plan is from MVP Health Care called “Platinum National Embedded.” It is considered a non-standard plan and therefore is “off-market” — not on the New York “Obamacare” health exchange — and is sold individually directly by the company.

A handy map shows which counties in the New York City region are covered:

A quick look makes it appear that all five boroughs of New York City are covered as well as two northern counties. When using MVP’s online plan lookup feature, entering my friend’s Manhattan zip code kept triggering an error. How could that be?

*MOUSE PRINT:

A closer look at the fine print asterisked footnote reveals that MVP is not licensed to sell these plans in any of the five boroughs of New York City, despite them being listed above as “included.”

We asked the company why it used such misleading representations and whether it would fix the distortions. They have yet to respond.

Finding the right health plan is hard enough without shenanigans like this.