Can I fill my prescription under the radar?

October 18, 2008 5:25 AM

How can I be sure that the prescription I'm about to fill won't appear in a for-profit prescription database?

I have a prescription that I need to fill but I'm sort of weird about privacy and I'd rather not have it appear in the mega-database of prescribed medications.

According to the above article, people who pay cash (and apparently they mean full price, not the $4 discounted Target/Wal-Mart prices) are "generally" excluded from this database. I'd like to be a little more confident about my exclusion from this database, so I've got questions:

Is paying cash/full price a reliable way to keep my prescription info private? Would I be better off buying from a Canadian or other non-US pharmacy since I'm already paying full price? I'm buying generic, so cost isn't really an issue. Mostly I'd prefer not to wait the three weeks it'll take to get them from Canada.

(Anonymous because I really am that much of a privacy weirdo) Questions, anonymous replies, etc: [e-mail]

posted by anonymous to health & fitness (7 comments total)

You could always have your doctor call it in under an assumed name. That's what celebrities do.

But that won't necessarily exclude it from a database. At least they wouldn't have your real name.
posted by FergieBelle at 5:27 AM on October 18, 2008

Actually that might not a good idea... I've been ID'd at CVS for DEA scheduled meds.
posted by crapmatic at 8:33 AM on October 18, 2008

I would think smaller "mom and pop" pharmacies might be your best bet, something that is not a chain.
posted by 6:1 at 9:14 AM on October 18, 2008

I think you're misunderstanding who ends up in the database and who does not. These databases are compiled by PBMs, which are companies hired (or owned) by your insurance company to process drug claims.

If you fill a prescription outside of your insurance--that is, you don't use your insurance to get the "discounted" price negotiated by your insurer, and you don't report it to your insurance company as something to count towards your deductible for the year--then the PBM isn't going to see your data, because they have no claim to process.

That's what the article means when they say people paying "cash" don't end up in there--it's slightly misleading, because if you hand the pharmacist your insurance card (or they have it on file), then you pay your copay in cash, you're gonna end up the database, assuming one of those PBMs is the one that your insurance company uses to process its claims. If you go into a pharmacy you've never used (that is, one that doesn't have your insurance info on file), hand them the prescription, when they ask about insurance say "I don't have any insurance," then you won't end up in any database. This is true even if you go to someplace like Walmart or Target for the $4 prescriptions--as long as they don't have your insurance information, you're good. (I mean, how would they report you? In all the years that I had no health insurance, I never had a pharmacist ask for my social security number or address when I was self-pay. All they know is your name, which isn't enough to make an accurate match in a database with millions of records.)

So: when you're filling your prescription, just go somewhere they don't have your insurance info, and if they ask, tell them you have no insurance. Your info will be safe, although you won't benefit from any discounts on the cost of the pills that your insurance company has negotiated with the drug manufacturer, which could be pretty substantial.
posted by iminurmefi at 9:29 AM on October 18, 2008 [1 favorite]

Cash vs Credit isn't likely to make a difference. But the Big Name pharmacies definitely do sell that data to database companies (who sell it back to insurance companies; funny since the pharmacies aren't allowed to sell directly to insurance). See: http://www.patientprivacyrights.org/site/PageServer?pagename=Campaign_for_Prescription_Privacy

I'd go to a local "mom and pop" and ask them.
posted by meta_eli at 9:31 AM on October 18, 2008

meta_eli, not that I would be shocked if Big Name pharmacies sell data to database companies, but I can't find anything actually supporting that in your link. Do you have any other links to something like that? Or am I missing that on your page?

It seems that all of the information on that patientprivacyrights.org site confirm my understanding of these databases--they are created when insurance claims for prescription drugs are processed. That's why "all 51,000 pharmacies in the U.S. are wired for data mining," as they claim on their site--every pharmacy is set up to accept at least one type of insurance, which means that they also are "wired for data mining" in the sense that they create insurance claims.

Even if pharmacies do compile their own records and sell them off to the database companies (which I'm not sure happens), if you're self-pay there is very little information that you need to give a pharmacy in order to fill a legitimate prescription. I can't imagine a situation in which they'd need your social security number, and again, I think it's unlikely that you'd be accurately matched based solely on your name (absent a SSN or health insurance number) to a file in a database with millions of records.
posted by iminurmefi at 9:55 AM on October 18, 2008

seems like this would need to be very explicitly opt-in to prevent massive class-action lawsuits under HIPPA . I'm pretty confident that any personally identifiable information would absolutely be covered here- the article also seems to explicitly mention opt-in. You may want to check your insurance company's published policies regarding customer privacy, but this really seems like a stretch for many reasons.
posted by jenkinsEar at 10:36 AM on October 18, 2008