Posted by Deborah14 on October 24, 2000, at 0:20:09
In reply to Re: Privacy Concerns: Info on MIB » Deborah14, posted by Greg on October 23, 2000, at 20:07:02
Greg:
If you would like, I'll elaborate further in a later post. However, in the meantime, please see the case Weld and Kelly v. CVS Pharmacy, Inc., Elensys, and Glaxo Wellcome, et al., which is now a class action certified in Massachusetts.In addition, most health insurance carriers in the United States now employ what are called Prescription Benefit Managers (PBMs) such as PharmaCare, PCS Health Care Systems, Inc. and MedCo. What is extremely troubling is that PCS Health Care Systems is owned by Eli Lilly and Medco is owned by Merck. The following are examples of medical privacy abuses that have occurred within the past couple of years:
1) The PBM that is contracted by the health insurance carrier receives copies of the patient's medications from the insurance company who reimburses the pharmacy for the prescription. Then the PBM contacts the patient's physician directly and advises the physician that their patient does not meet the criteria to receive the drug and that the doctor must stop prescribing the medication or taper the patient off the prescription. The doctor is then requested to fill out a form, sign it and send it back to the PBM indicating what course of action they are going to take. (see case of Dr. Louis Halfkin, a psychiatrist at Harvard Pilgrim Health Care of New England and PharmaCare)
2) In the case of Merck and Eli Lilly, they were receiving information from their corporate owned PBMs, Medco and PCS Health Systems, Inc. about patients who were being prescribed competing pharmaceutical company's medications. The prescribing physicians were then receiving calls from the PBM compliance agents who were falsely identifying themselves as the patient's pharmacist and requesting that the doctor switch the patient to the competing drug companies medication (i.e. medications manufactured by Merck or Eli Lilly). Hubert H. Humphrey III, attorney general of Minnesota, lead a 17 state consumer protection settlement with Merck and Eli Lilly to amend these practices. The practice affected 41 million Americans.Have you ever received a letter from the PBM contracted by your health insurance carrier saying they will no longer pay for a particular medication your have been prescribed and that your physician will now has to switch to an approved medication from their list. I have. How do you think the PBM knows what medication you are taking? They know because in order for your pharmacy to be reimbursed for the medication your physician has prescribed and in order for you to have to pay the pharmacy only a copay for purchasing that medication, the pharmacy must reveal to your insurance company, many times through the PBM, that information. That is exactly what the computer is doing everytime you go into your neighborhood CVS, Walgreens or RiteAid, etc. The data is being transmitted to the PBM. Have you ever gone into the pharmacy early to refill a prescription because you have run out and the pharmacist has declined to refill the presciption. Primary Reason: PBM! The PBM is managing your health care, not your physician.
3) The worst abuse of this system is now with the purchase of pharmaceuticals offered on-line or through the mail through a PBM contracted by your insurance co. In return for lower prices, usually a 90 day supply for the same copay as a thirty day supply, your health care and medical records privacy is being managed and invaded by the PBM.What is especially disconcerting for people suffering from mental illnesses is that they often have worked years with their pdocs to find just the right combination of medications to controll their symptoms. Sometimes, the particular combination is very drug specific and there is no substitute in the same family that works as effectively or effectively at all. Never mind that the insurance company won't pay for therapy, but what happens when someone who doesn't know you and isn't a physician but rather a clerk who is reading from a list and spouting the insurance company's "party line" is telling your physician what medications you can or cannot take. This is occuring everyday in our health care system. It is occuring to manage costs and not illnesses. Patients' medical privacy is being invaded when insurance companies through PBMs are entering computerized records under the guise of cost controls and prescribing medications in lieu of physicians.
poster:Deborah14
thread:47148
URL: http://www.dr-bob.org/babble/20001022/msgs/47223.html