I know there's an opioid epidemic that is apparently a leading cause of accidental death, so I wasn't entirely surprised when I got a call from Walgreens about a script I wrote for one week of narcotic for a patient to go home with.
I was like, fine, if Walgreens wants to call every single doctor to ask him about every single opioid prescription, let them do it. Maybe it's a good idea.
But then Walgreens started asking me questions about the patient. Like their diagnosis. And I felt a little uncomfortable giving that information out, so I didn't. Isn't it a violation of HIPAA for Walgreens to be asking me patient information? I don't know if I would want Walgreens to know all my medical information.
Yes, it is a violation of HIPAA.
ReplyDeletenot a HIPAA violation. The RPH has a duty to ensure there is a patient - doctor relationship and the narcotic is being written for a legitimate reason. The RPH does not like this, they did not go to school to be the narcotic police but between the DEA and BOP that is what they have to do.
ReplyDeleteWhile I have nothing to hide I dislike giving personal information to any corporation, even though it's a necessary evil, especially a for profit company. The emphasis on the bottom line is a great temptation to buy and sell such information as is the quest for easy wealth.
ReplyDeleteI'm a Canadian pharmacist, so maybe the laws are different here, but we're considered as part of the patient's circle of care, and we are allowed to ask for this kind of information to determine if the prescription is right for the patient.
ReplyDeleteWaiting a week to fill an opioid script? I would be suspicious too. In my own experience, I needed the drug immediately and by a week later I was on OTC meds for pain. I know I have had a few pills when discharged from a hospital but really a whole week. Hmmmmm
ReplyDeleteI think you misread. It's a 1 week script not a script she wrote a week ago
DeleteAs I understand it, that is not a violation of HIPPA. The pharmacist is part of the patient's care and they also have to follow all HIPPA guidelines, so sharing medically relevant information is allowed. I'm not a lawyer, obviously, but if you want to be sure, hospitals usually have a person you can consult on issues like this. I know the hospital system I used to work for did.
ReplyDeleteIn New Zealand the law allows health providers to share information about patients they are both providing care to - so Doctors and Pharmacists (and other health professionals) can share information with each other about a patient they are providing services to. I realise the law may be quite different - but I'm glad we can share information in this way.
ReplyDeleteI found it interesting that you said you got a call from Walgreens and your concerns about sharing information with Walgreens .... I'm guessing that it was a pharmacist, a fellow health professional, who rang you? Or are pharmacists not considered to be part of the health team?
I definitely think that our pharmacists are part of the healthcare team. My question is just if random pharmacists from a large company are entitled to private healthcare information.
ReplyDeleteIf you want them to fill the prescriptions you write - then yes, they are privy to that information. We're just like any other provider with a license - documenting the hell out of things so our own asses are covered if things go south. If I thought something was fishy (granted, a 1 week prescription isn't about to raise my eyebrows no matter what pain med it is) and then the doctor wouldn't give me a diagnosis/reasoning behind the Rx, I would refuse to fill it. Every area has doctors writing scripts they shouldn't be writing - and the big box pharmacies aren't going to back us up if the DEA comes around.
DeleteThis comment has been removed by the author.
DeleteSometimes the patients insurance, especially medicaid, requires diagnosis codes. Also if they have gotten multiple opioid scripts in sucession even if they are not too soon, they will want a reason.
DeleteAre they a random pharmacist if they are filling that patient's prescription? Aren't they then that patient's pharmacist? (Although if it's anything like here - people will often use several different pharmacies, so it can be hard for the pharmacist and the doctor to establish a relationship of cooperative care for a patient).
DeleteThe individual pharmacist may have a legitimate need to know if a physician- patient relationship exists which was verified by the phone call. I think a good case for a HIPPA violation could be made especially if the corporate entity recorded the diagnosis. If the diagnosis involved a protected class like HIV or psych info, it would, for sure be a HIPPA violation. I would think the individual recording the diagnosis or the corporate entity would be most vulnerable to litigation. The physician could simply deny providing the diagnosis.
ReplyDeleteI am guessing it is perfectly legal - and I agree a little uncomfortable. I even see the purpose. Of course the pharmacist is part of the care team. Pharmacists often catch important mistakes and some inquisitiveness is a good sign. But if it made you feel uncomfortable there is probably a reason you did. Not sure what was behind it. Wonder what the best response is? … Maybe something polite like "I appreciate your extra care for this patient. I wonder if there is a particular concern that is prompting these questions?"
ReplyDeleteDefinitely not a HIPAA issues - pharmacists are covered.
ReplyDeleteI get uncomfortable with the HSAs wanting this information! Yet more and more are wanting it to allow the patient to be reimbursed.
It's because Walgreens got dinged by the DEA and created a whole new policy on dispensing pain medications. After they go through the checklist, they have the option to call the doctor if they still aren't comfortable with the prescription for any reason. Here's the relevant part:
ReplyDeleteBased on the results of the previous steps and questions, Walgreen's checklist instructs pharmacists to use their "professional judgement" (sic) to determine whether the prescription should be filled or the pharmacy should take the additional step of calling the prescribing doctor to ask more questions.
If a call to the physician is needed to further verify the prescription, the checklist directs Walgreens staff to "verify/confirm any number of the following points" with the doctor:
Prescription is written within prescriber's scope of practice
Diagnosis
Therapeutic regimen is within standard of care
Expected length of treatment
Date of last physical and pain assessment
Use of alternative/lesser prescription medications for pain control
Coordination with other clinicians involved in patient care
http://www.wthr.com/story/23469086/2013/09/18/walgreens-secret-checklist-reveals-controversial-new-policy-on-pain-pills
I wouldn't feel comfortable with a random pharmacist knowing what my diagnosis was. Sure, they can guess a lot of stuff based on the medications. I don't want some random floating pharmacist to know what my diagnosis is. This can be a person I've never seen, because I dropped my prescription off before they started working and my partner got my meds for me. This stranger who is filling in for a regular doesn't need to know my diagnoses.
ReplyDeleteI do have chronic pain and take narcotics long term for it. When I switched to my current pharmacy I got to know the pharmacists. After that, one of them asked why I was taking the pain medication. I can't remember why she asked but I think that she was just curious because I looked pretty good. I look good because I have pain relief! But I felt entirely comfortable with being asked and telling because I have a relationship with these pharmacists.
I'm sorry, but this is a little naive. Anyone who has touched your prescriptions -- doctors, MA at the office, nurse, pharmacy technician, pharmacist -- can make a pretty good guess at your diagnosis. And at least these are licensed professionals that are (theoretically) held to a very high standard. Your insurance company knows your diagnosis, and the vast majority of the people handling your claims have no professional compunction. If your prescriptions have any ICD9 or ICD10 codes on them, anyone who sees them can look up and find out what is wrong with you.
DeleteAs for a float pharmacist -- if they don't know your diagnosis and some quack prescribes you something that could kill you, stating that they didn't know what was wrong with you is not going to save their license or protect them from a lawsuit. Licensed medical professionals have a moral, ethical and legal obligation to not screw up. Just be glad that there are medicines to help you. No more first world problems, ok?
Even Fizzy didn't feel comfortable giving a random pharmacist a diagnosis, so I'm not sure why you're calling that a first world problem. I bet you could have been even more condescending though.
DeleteFirst world problems usually refers to trite problems, like "I can't decide if I should get a blue car or a gray car." I agree that not wanting your private health information shared doesn't really fall under that category. It's like telling a patient who becomes violently ill during chemotherapy that it's a first world problem because they should be lucky to be getting treatment. What problem do ANY of us have in our lives that aren't first world problems?
DeleteMy next post is going to be about how I'm getting parasites from the well outside my hut where I get all my drinking water.
First world problem....at least you have water!!! ��
DeleteThanks for always looking out for your patients (I do see both sides of this issue)!
I'm not sure what the specific requirements are, or if they vary by state, insurance provider, or pharmacy policy, but some schedule II scripts do require diagnosis codes prior to filling. Our electronic medical record automatically supplies the diagnosis code on the printed script, but on occasion if I am handwriting a script and forget to write the diagnosis code, the pharmacy will call. I have never had a pharmacist imply that the diagnosis is not legitimate or "bad enough" to warrant the treatment I prescribe. I don't consider it a HIPAA violation because the pharmacist is part of my patient's healthcare team, but if it is a sensitive or potentially embarrassing diagnosis, I will choose a very general diagnosis code to put on the script while reserving the specific diagnosis for my own note and billing.
ReplyDeleteNo disrespect to the RPH's out there..But until pharmacy patrons are patients & not customers I'm not incredibly excited about my info shared! But I see both sides! Katrink might have the perfect solution! I know the customer vs patient is the higher up mentality; it's tough!
ReplyDeleteThey are part of the care team, it's not a HIPAA violation. I see no problem whatsoever with a pharmacist knowing WHY a patient has been prescribed a medication. Especially with some EMRs using simple "pick a med" menus for prescribing, your dr could click the wrong thing accidentally and you'd be taking an antiarrhythmic instead of that antibiotic.
ReplyDeleteThey are part of the care team, it's not a HIPAA violation. I see no problem whatsoever with a pharmacist knowing WHY a patient has been prescribed a medication. Especially with some EMRs using simple "pick a med" menus for prescribing, your dr could click the wrong thing accidentally and you'd be taking an antiarrhythmic instead of that antibiotic.
ReplyDeleteAs a pharmacist I will give my opinion. Once a patient presents a prescription to us they become our patient, not a customer (a customer is someone who rings up toilet paper at the pharmacy counter without picking up a prescription). Therefore any information we need to safely and accurately fill a prescription would not be a HIPPA violation. Diagnosis codes help prevent errors. For instance, I once had an rx presented as "clondidine 0.1 mg take 1 tablet at bedtime fro restless legs" - long story short it was intended to be for clonazepam, and was a drop down menu error on the part of the prescriber. By putting the diagnosis on the script, the Dr and I together were able to prevent a medication error. We arepart of the team and deserve to be recognized as such. After all, the main goal of any healthcare provider is to make sure the patient has the best possible outcome is sit not?
ReplyDelete