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?
