Protecting Your Confidential Patient Information

Protecting Your Confidential
Patient Information

We are now faced with a back handed and unscrupulous attempt by managed care organizations and pharmacies to obtain your confidential medical data by requiring providers to give "Authorizations" for a medication not covered by a health plan. By law, the correctly written prescription is an immediate and automatic legal authorization for the pharmacist to dispense the prescribed drug. In reality, however, managed care organizations use this term "Authorization" so they can determine your care and choose your medicines. We are being asked to release your confidential medical information without your permission and without your even knowing anything about it!

Background Information.

In order to oversee prescription drug benefits for employees and medical plans, a new breed of managed care has arisen, called Pharmacy Benefit Managers (PBMs). They do the following:

Operate mail order services
Develop a list or Formulary of preferred medications, based on cost.
Negotiate "rebates" from drug manufacturers for their drugs to be included in this formulary. These rebates occur when drug companies pay CASH to managed care companies for high volume sales of their product, on top of the best-negotiated price!
Contract with pharmacies to negotiate drug price discounts and monitor customer services. (Note the words "monitor" and "customer")

We write prescriptions that are based on the best needs of the patient. We are all aware of costs and often prescribe less expensive but therapeutically equivalent substitutions. Pharmacists are encouraged (by the PBMs) to use formulary drugs and will receive a fee increase for each generic drug they dispense! (Another kickback) By California law, pharmacies can dispense generics only if the prescription allows it. Patients also have to be aware of "switching" by the pharmacies. Switching occurs when the prescribed drug is changed to a different formulary brand name that may not be chemically equivalent. Be careful when you pick up your medications!

If the doctor writes a prescription for a medication that is not on their list, the pharmacist or the PBM will call the doctor's office for an "authorization". To comply with this "Authorization", we must release to the pharmacist or the PBM your personal medical data, so they can determine if the drug is appropriate!!

There are three very important implications here.
First, is that your doctor or nurse do not know what to prescribe for you. They presume to know, without an examination or even talking to the patient.
Second, the information they want is your diagnosis, date of birth, past medical history, prior medications, --any and all information they deem necessary! This information is shared and sold throughout the healthcare industry and is stored in the medical data banks. Your confidential information becomes readily available for anyone to see.
Third, they want this information without obtaining your permission! This is illegal. It is against the Confidentiality of Medical Information Act (Civil Code § 56.10), a law that guarantees that no patient information shall be released or disclosed without a patient's signed authorization. The consequences for providers who violate this law are high: civil and criminal penalties with loss of license. "It's Ok, all the doctors do it", say the pharmacists. Well, it is illegal and not OK. Every patient should ask if their doctor or provider is releasing private medical data under the guise of pharmaceutical "authorizations".

Therefore, we will give "authorizations" for medications to pharmacies and PBMs only if it does not disclose your confidential medical information. If you want us to give out your personal and private medical information, to get the medication you should have gotten to begin with, you will have to give us your written consent to do so.

What is your price for privacy and good healthcare without any third party intervention? Isn't that why you chose not to join an HMO? ` The above law does not apply to patients who belong to an HMO. These patients have no expectation to privacy (as indicated in the policy contract) and all the medical records belong to the HMO and not to the provider.

We continue to be your advocates in the continuing fight for your patient rights. You need to know what is happening and how it affects you. Your human resources departments and employers need to know that the same applies to them when they require medications. Employers should be wise to the industry spin that "information is kept confidential" and "only specially designated individuals" will get this information, or that all this results in "better, less expensive and more cost effective healthcare". It is very obvious, by looking at the "rebate" structure of the managed care PBMs and pharmacies, who is making the money and, more importantly, where the cost savings are going.