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Prescription Insurance Tool Evaluates Consumers

New Database Provides a Pharmacy Risk Score for Insurance Coverage

Sep 22, 2008 Martha R. Gore

Prescription insurance companies have access to a powerful new database tool that provides a "credit" report of pharmacy records on more than 200 million Americans.

Prescription insurance companies are now collecting and analyzing personal drug information using electronic medical records. Some companies have already begun testing systems that not only tap into prescription drug information but also data being held by clinical and pathological laboratories. The question remains as to how deeply this data system will effect the ability of consumers to obtain prescription drug coverage.

Prescription Insurance Companies Risk Evaluation

Prescription insurance companies have traditionally assessed an applicant's risk by gathering medical records from doctors’ offices. With new tools such as Milliman and IntelliScript, which provides personal drug profiles to insurers, the new system is electronic, fast and cheap. However, according to Tim Sparapani, legislative council at the Civil Liberties Union, these practices should be stopped before being fully developed because consumers could lose all control of their medical information.

Prescription Insurance Company Consumer Reports

Prescription insurance companies using systems such as MedPoint and IntelliScript come under the Fair Credit Reporting Act and must notify the insurer that a consumer who is denied coverage on the basis of these reports may request a copy of the report and if there are any errors, to correct them.

Prescription Insurance Company Profile Methods

Prescription insurance companies using the new database tools will use profiles by accessing prescription drug histories kept by pharmacies. These will then be fed into the database, going back as far as five years, including drugs and dosages, filled and refilled dates among other information. That will be followed by an analysis and then assigned to a code to determine whether the applicant will be accepted by the insurance company. According to some, this will lead to mining other data about patients and perhaps blacklisting.

Prescription Insurance Company Database Pros and Cons

Prescription insurance companies declare that using the databases will make for improved health care and cost savings. Privacy and consumer advocates fear it is taking place outside the scrutiny of the federal health regulators and lawmakers. They argue that the electronic data gathered for one purpose can be used for marketed for another, all without the consumer's consent.

There is no way of stopping the genie that is already out of the bottle but a privacy proposal pending in Congress would at least expand the government's ability to regulate “downstream” organizations, audit their activities and impose civil fines avoiding the corruption of this personal information.

Bibliography:

American Civil Liberties Union. ACLU Urges Congress to Ensure Privacy of Electronic Health Records. June 25, 2008

Privacy Digest. Prescription Data Used to Access Consumers--Records Aid Insurers but Prompt Privacy Concerns. August 6, 2008.

Sources:

Federal Trade Commission

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