Privacy Rights Clearinghouse (PRC) has persistently challenged the health care industry’s improper use and disclosure of confidential medical information, which in many instances is used to market new or additional medication to patients. PRC has become aware that Caremark, a CVS owned company and one of the country’s largest pharmacy benefit managers (PBMs), is improperly sharing prescription information with CVS to steer pharmacy patients to CVS pharmacies.
Prescription benefits are an essential coverage provided by most health insurance plans. The increasing size and complexity of the pharmacy benefits and payment process causes many plan sponsors -- employers, HMOs and others -- to contract with PBMs for administrative services and to assist the containment of medical costs. PBMs like Caremark are essentially administrators that process payments to dispensing pharmacies, handle payment claims, and negotiate reimbursement rates with pharmaceutical companies.
It appears, however, that Caremark may not limit its activities to those appropriate for PBMs. When Caremark was acquired by CVS in 2007, CVS recognized the potential misuse of the sensitive information handled, and promised that Caremark would be “agnostic to where the consumer fills their prescription.”1 This statement is apparently false. Rather, Caremark allegedly discloses confidential patient medical information to CVS marketing specialists who use it to develop programs intended to increase CVS pharmacy business. This is seemingly done without the knowledge or permission of the patients.
Rather, after Caremark obtains patient prescription information to process claims for payment, the patients often receive communications encouraging them to fill prescriptions through CVS. PRC has been informed of calls and letters from CVS to patients of Caremark-administered plans requesting they transfer their prescriptions to CVS pharmacies. Other reports indicate that some Caremark patients are automatically enrolled in CVS’ “ExtraCare Rewards” program and sent coupons redeemable only at a CVS pharmacy.
Using patients’ medical information for these types of marketing without authorization is improper. Medical information is extremely private and safeguarded by most states from unauthorized use.
If you or a loved one is in a Caremark-administered health plan and has been asked, or required, to fill your prescription at a CVS pharmacy, letting PRC know could help an ongoing effort to halt the misuse of confidential medical information.
1 Mina Kimes, New Troubles for CVS Caremark (Forbes, March 23, 2010). http://money.cnn.com/2010/03/23/news/companies/cvs_caremark_pharmacy.fortune/index.htm