Question about Patient Consent and Potential HIPPA Violation With Insurance

Prescription Insurance Consent/Privacy

Prescription Insurance Consent/Privacy

Do you have to give consent for the pharmacy to provide your information, or a prescription, to your insurance company?


If the pharmacy faxes the prescription to the insurance company, which is required by the insurance company for certain prescriptions for a pre-authorization, is that a HIPPA violation?

Answer:

My questions for you are these:

Did you give the pharmacy your prescription insurance information? If not, then how did they get your insurance info?

Did you give the pharmacy your prescription? Did you request the pharmacy fill your prescription and run it under your insurance?

My point is that if your expectation and desire was to have the pharmacy fill your prescription and run it under your insurance, and you gave both to the pharmacy, why would it be a HIPPA violation for them to do what you are requesting and expecting them to do?

Prior Authorizations involve the pharmacy contacting the prescriber and requesting the MD or ARNP or nurse practitioner to make contact with the insurance company. The prescriber will provide the insurance company with required clinical information so that the insurance can make an informed decision to pay or deny the claim. During the course of normally filling a persons prescriptions, the claim is transmitted electronically from the pharmacy to the insurance. This is done through the internet, using the pharmacy's software program. Nearly all parts of a prescription (Patient name, drug, quantity, directions, doctor name and NPI or DEA number, etc) are sent to the insurance company anyway. Sending a copy of the prescription to the insurance for a prior authorization seems to me to be a non-issue in terms of HIPPA. The insurance already has all of the info.

As for the issue of consent, most pharmacies wouldn't do anything that hasn't been requested of them to do. You've given the prescription and your insurance to them. You've not told them to not run it through your insurance. The expectation here is that they will.

If you'd rather not use a particular pharmacy, you always have the option of getting your unfilled paper prescription back. However, if the prescription has been filled once or more, and picked up, the RX must be retained by the pharmacy for record-keeping purposes. A pharmacy employee will also be able to reverse the filling of the prescription thru your insurance.

Thank you for the question.

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