ASK THE PHARMACIST: Confidentiality in the Pharmacy; What are Your Rights?

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. 

It often becomes challenging for pharmacy employees to handle all the variety of customers.  During a normal busy day, especially at the register, the pharmacy personnel will need to verify certain information.  Unfortunately, if bystanders are standing close, they may be able to hear your conversation.  Overheard information is questionable in how it fits into the law. To bypass this, many pharmacies are putting up ropes or markers a few feet back from the counter and instructing patients to wait there until called to the counter. This helps alleviate all privacy issues. 

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  

Comments

[astermeds.com]

good content.. thanks for the post..

[Will]

I've always wondered about this situation! Thank you the ID idea is excellent and I am going to use it in the future, I hate it when they ask out loud what scrip im picking up, and everyone is listening... thank you!

[Roxanne]

Thanks for sharing such valuable information. Keep posting such great info for us, thanks.

[Todd Martell]

I am writting to you about a very serious matter about my pharmacist of 10 years giving out information about me and my medications to my mother,this my sound petty to most people but I feel that there has been a confidental breach here and this has been going on for quite awhile now,I feel that I have no rights here and I can,t do anything about this situation.I have not given the pharmacist any permission what so ever to do so.This is impacting on my private life and family life as well,what if any,can I do about this situation,please help me with any imfomation you can give me, as this is weighing heavily on me,I am a 43 year old man with cronic back pain and I have just had an ICD inplant reasontly put in as I have a very serious heart dissease and I don,t wont any imformation given out about this to my mother or anyone,please help me in this matter please

[cialis sverige]

Yes, pharmacies must to care about their clients security and privacy.

[Lucy]

Overall it is good, but I did notice a few gmramar things you might want to correct just in case they are really picky about that. In the 3rd paragraph, first sentence take the s off health profession.Nelt to last paragraph make the sentence that starts I know that I can excel into two sentences. Also in the last paragrah, second sentence change because to that. Also you might want to write out MCPHS. Sometimes little details like that make a difference.

[Renata]

WELL, were I live(CA), crocs are a crime to human nature uenlss you're an old lady picking vegtables out of her garden or a baby at the beach. Most people refuse to wear them. But, in your condition, it shouldn't matter what other people think about what's on your feet.

[Yuni]

j:As long as you remain a full-time stuendt, you will continue to qualify for in-school deferment . You won't have to begin paying your loans back until you finish law school.The only requirement is that you remain registered at least half-time at an eligible institution, and that you don't take more than 6 months off at any time during your schooling.By the way this is an automatic feature of government-backed stuendt loans (Stafford/Perkins/PLUS), but it is not necessarily characteristic of all private loans. Also remember that the in-school deferment requires attendance at an eligible school. Some stuendts have pursued law or medical degrees at foreign universities, only to discover that some of these schools are not participants in the Federal Student Aid program, and therefore, ineligible for in-school deferment.I hope that helps good luck to you!

[John M]

If a pharmacist violated your confidentiality by discussing your medication and medical condition with anyone without your consent, then you should file a complaint with the state board of pharmacy. For those on HIV medications....prescription drug plans and corrupt PBMs will try to steer you to a specialty pharmacy and/or mail order. You can opt out of these without penalty, if you file a grievance and verbalize the relevant issues as to why this is unacceptable medical care. There were two lawsuits filed in California regarding this issue as it pertains to HIV patients, but many of the issues are relevant to patients with other chronic medical conditions. Check out the consumer watch dog website for information. Assert your right to fill prescriptions for HIV (and other) medications at your local pharmacy. Many PBMs own the mail order companies that dispense the prescriptions. It is a blatant and corrupt conflict of interest. Note the objections and enclose a copy of the lawsuit. You will be allowed to opt out. If enough people object, it will be the death knoll for mail order and so-called specialty pharmacies. Specialty pharmacies have their place for expensive, rarely used drugs that require careful handling, but they have no business dispensing drugs for chronic conditions that happen to be expensive, but are stable preparations and can be more efficiently and professionally dispensed at a retail pharmacy. Best wishes in your quest for fair treatment and access to care.

[Heather McFarland]

Pharmacists just need to ensure they do all they can to ensure the safety and security of Protected Health Information (PHI), which essentially means never discussing one's medication and medical issues with anyone except the actual patient. It's really that simple. So this falls under the broad-based HIPAA Privacy Rules, which means that pharmacies should be focusing on the true merits of HIPAA compliance, and that’s putting in place documented HIPAA information security and operational policies, procedures, and processes. I’ve worked with so many healthcare providers that lack the basic and fundamental documentation for HIPAA compliance, therefore it’s easy to see why non-compliance issues are still a major factor with HIPAA. I also hear healthcare companies express cost concerns about developing such documents, along with implementing risk assessment and security training initiatives, but with all the free and cost-effective tools available (some of them straight from hhs.gov!), there’s really no excuse for not being HIPAA compliant. Everyone needs to be ensuring the safety and security of PHI, it’s really that simple.

[340b Pharmacy]

Thanks for the valuable information on this subject!

[Sandy AS]

What about when you go to the consultation window and request the pharmacist. You explain to the tech that a doctor next door to them sent prescription, testing and otc medication information over.

The tech wasn't familiar with the name of the test; yelled at the pharmacist 10foot back in front of everyone about a 'mono' test.
The tech didn't know what it was the pharmacist not only never walked over to me, but continued to openly discuss which doctor, what prescriptions, what other information?
Explains to the tech what the illness is and still never came to the counter to assist me despite requesting that they stop discussing the information openly?

Told her that I didn't appreciate the privacy violation in front of the manager after I was also required to go get new information walking in out of the store, he noticed that I was coming in again asked why and I explained briefly the incompetence going on.

Transferred the prescriptions to another pharmacy entirely and information my insurance provider.