Q: "I was in to pick up my monthly prescriptions for HIV medications the other day. The clerk behind the counter told me my prescriptions for HIV medications had to be filled elsewhere now because it's a specialty medication. There were several people around, and she used the word "HIV" when addressing me. I don't like to disclose my status to strangers. I'm wondering if I should report this. Aren't there pharmacy rules on confidentiality? Also, have you also heard about insurance that does not cover HIV medications at a normal pharmacy?"
A: In short, it sounds like this information was exchanged near the cash register, and at the very least, this 'conversation' should have been taken to a more private area. Ideally, the pharmacy would
have contacted you by phone to review this insurance issue before you even came in. But unfortunately,
that's not the case, and this kind of scenario happens much more often than people think, and it's important to know how to handle it.
In hindsight, any member of the pharmacy staff should use extreme caution when discussing any PHI (protected health information) with a patient at the pharmacy. (PHI is any individually identifiable health information.) Because of the changes in the HIPAA (Health Insurance Portability and Accountability Act), the patient has very explicit rights when dealing with PHI. That said, the HIPAA laws are vague on information that is "overheard" by other individuals that may be standing around the patient area when information is being discussed.
In a high traffic pharmacy, hundreds of patients cross the register daily. Some people will yell out in front of a waiting room full of strangers, “I want to pick up my Viagra and Xanax,” and not blink an eye. Other people are much more discreet and don’t want this information known by others.
There is also typically an area for counseling that is separate from the prescription pick-up area. In your situation, you should have been taken to this area, where this issue should have been discussed. Pharmacy personnel, especially at large chains and clinics, receive special training in proper jargon to use at the register, on the phone, what info can and cannot be left in a voicemail, etc. In the future, if you want to protect your information, you can show the cashier your ID instead of saying your name out loud, and ask them to please not verbalize your information. I have patients who have asked for this, and I have added these instructions to their profile. This has worked in all cases. If you feel strongly that your confidentiality was violated, I urge you to contact the pharmacy manager of the facility where this happened and discuss the issue with them. You can also go to the HIPAA website and file a claim with the organization directly. They will investigate any issue to the fullest extent.
In response to your additional question, there has been a shift where insurance companies are requiring all specialty medications be filled in-house, or via their own mail order pharmacy. HIV is classified as a specialty disease state since the medications are very costly. Depending on your insurance, you may be required to get your HIV medications filled mail order through your insurance. However, in my experience, all other non-specialty medications can be filled at your local pharmacy. Contact your insurance company directly for this information. They would be best equipped to answer this question. -- Heath P. Dobson Jr., BS Pharm, RPh