A Pharmacists Response to PBM Data-Mining – CVS/Caremark Caught in the Act

By: Christian Tadrus, Pharm.D., R.Ph.
Moberly, MO

A Pharmacists Response to PBM Data-Mining

This issue of data-mining dispensing data in order to influence prescriber and customer behavior should be on the radar of every pharmacist, pharmaceutical provider and pharmacy organization in the country as the practice brings up a whole host of issues not the least of which is pushing for inappropriate therapeutic switches.

There is also evidence that some PBMs are using this data mining technique to identify expensive specialty and even often inexpensive maintenance medications from claims data and then contacting patients directly with letters suggesting that they begin ordering these medications directly from the PBM-owned mail-order houses often enticing the customer with a very specific cost savings offer if they switch.

Considering that all PBMs such as CVS Caremark require pharmacies to provide patient-specific information in order to pay a claim, this practice might be equated to forcing pharmacists to provide the bullets for the gun with which they will soon be shot.

To read the story this post refers to click here.

Christian Tadrus, Pharm.D., R.Ph.

Comments

  1. Christian Nice Blog.
    What are the HIPPA implications?
    In another area, Do MoHealthnet members give permission to Cyber Access to release their information to users of the software?
    Chuck T
    Take Better Care of Yourself
    KCMO

  2. Chris,
    Just wanted to add to this “mining for information”. I have a close R Ph friend that almost lost a customer to a MAJOR-(translate that to large) competitor because an insurance company wrote a letter to her patient informing the patient that MAJOR would give better pricing, this was followed up by a phone call from a solicitor from the insurance company. Luckily she knew the patient well enough to stop MAJOR and MEDICARE D NO NAME plan in their tracks. PS Patient has now changed MED D provider as well. Becky Culbertson

  3. Christian Tadrus, Pharm.D.,R.Ph. says:

    Chuck,

    HIPAA violations certainly are of concern here. However, HIPAA does allow for insurers and providers to communicate with their members/subscribers/customers if they have a bonafide relationship. The CVS/Caremark merger has complicated the separation issue a bit as the PBM side has access to claims data and the net result of the “switch” is to route patients to the provider side.

    As to MO HealthNet, I don’t know the answer to your specific question. You can perhaps find out at http://www.dss.mo.gov/mhd/index.htm or by calling the MO HealthNet Division directly at telephone: (573) 751-3425

    Regards,

  4. pharma companies use data mining in a different sense, and does not disclose patient information, yet is clearly deceptive- along with privacy issues.

    The AMA sells this information to pharma companies to target particular prescribers.

  5. Christian Tadrus, Pharm.D., R.Ph. says:

    CVS Caremark is definately using their claims database to route customers to their retail and mail order stores. As of the last week of December, retired federal employees have begun receiving letters stating that prescriptions must be filled at a CVS pharmacy or via CVS Caremark mail order.

    This letter identifies, very specifically, the last pharmacy the patient visited and states that they can no longer have their prescription filled at that pharmacy. This is not a simple “you can get this cheaper via mail order” comment. It is very direct.

    NCPA is currently seeking information regarding this type of practice (and specifically CVS Caremark examples.) If you have evidence of such activity, please contact NCPA at 703.683.8200 or by emailing info@ncpanet.org.

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