1984, insurance, medicine, PBMs, pharmacies, primary care

Big Brother is watching.

I’m willing to bet that most people think that what happens in the exam room is just between them and their doctor.

How wrong they are.

The Health Insurance Portability and Accountability Act (HIPAA), which came into effect in 2003, states:  A covered entity (that’s your doctor) may disclose PHI (Protected Health Information) to facilitate treatment, payment, or health care operations without a patient’s express written authorization.”

That means that all of your private health information can and is shared with your insurance company, pharmacy, and pharmacy benefits management company (like Caremark and ExpressScripts).  Don’t think they’re interested in what you’re doing?  Wrong again.  I am constantly getting “helpful” communications from them regarding what you’re doing.  Here’s an example:

Not taking your medication?  Don’t think I’m not going to find out!  Your pharmacy keeps track of how often you refill your pills.  They pass on this information to your insurance company.  They pass it on to me so I can…scold you?  Rap your knuckles?  Send you to bed without dessert?

I don’t find these communications helpful.  I find them insulting to my intelligence.  I know people don’t take their medications all the time.  No one does.  There’s lots of research to back this up.  Because I know this, I monitor their chronic issues.  I bring them in for blood pressure checks.  I do lab work.  I do physical exams.  If something is not as it should be, I address it and work with my patients to make changes they can live with.  If everything is A-OK, we leave it alone.  I don’t need to parent my patients.  That’s insulting to them.  I’m an internist- I take care of adults.  If I wanted to treat people like children, I would have been a pediatrician.

So, I’ll keep on adding on my own little check box that states “I find this communication to be useless.” 

Even if Big Brother wants me to scold and nag.  

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