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.

Click here to post comments

Join in and write your own page! It's easy to do. How? Simply click here to return to HIPPA Question Invitation.

Back to Home

[?]Subscribe To This Site
  • XML RSS
  • follow us in feedly
  • Add to My Yahoo!


Didn't find what you were looking for? Use the box below to search this entire site.

Custom Search

Recent Articles

  1. Pharmacy IV Math Question: Weight/Volume Dextrose in Water to Add to 500cc D10W

    Jun 21, 17 11:12 PM

    A pharmacist an IV which is 8% w/v dextrose in water. How many cc of pure sterile water should she add to 500cc of D10W to make the IV? I would appreciate

    Read More

  2. Dilute 1gm/5mL Cefazolin stock to 15mL of a 50mg/mL. How much diluent and stock solution is needed?

    Jun 21, 17 11:08 PM

    Prepare 15 mL of a 50 mg/mL cefazolin dilution from a stock of 1 g/5 mL. How many milliliters of diluent and stock solution will be needed?

    Read More

  3. Atrovent Inhalation Solution 0.02% 2.5ml Vials: What is the Qty for a 34 Days Supply?

    Jun 21, 17 11:03 PM

    Atrovent Inhalation solution 0.02%; 2.5 ml X2 vial dispense; 10 boxes 1 vial q.i.d 2 refills 34 days supply third party plan cover Qty___? ; refill____?;

    Read More