My Pharmacist and Me: How California Pharmacists Can Help Protect Patient Privacy

As pharmacists prepare to step into the ring of providing sensitive family planning services to their patients, it is important to brush up on patient confidentiality strategies, especially as they pertain to teens.

But wait…isn’t that what HIPAA is for?

Well yes… but wait there’s more! Once the statewide protocol for pharmacy access to hormonal contraception gets approved in California, pharmacists are likely to see teens pursue this option as a confidential, convenient way to get effective birth control. As a pharmacist, you should know that in the State of California, minors are allowed to obtain birth control without parental consent. In fact, you legally cannot discuss any family planning issues with a minor’s parents without the patient’s written permission. While you should encourage teens to keep open communication lines with their parents, you need to respect their decision if they choose to keep their sexual health a private matter. Knowing that they can trust their pharmacist to keep their healthcare private is VERY important to teens and they would benefit from being assured that you will keep their information confidential.

How does the ACA affect patient privacy?

The Affordable Care Act not only expanded insurance coverage for young adults through their parent’s plan up to age 26, it also provided complete coverage for birth control for women. This brings up an important dilemma, patients may now have expanded coverage for birth control, but they may be afraid to access it because of privacy concerns. While you have provider-patient confidentiality laws to adhere to, the insurance companies do not have to keep it confidential. This means that if your patient uses her insurance to cover her birth control, but her parent or spouse is the policy holder, then the insurance company could send billing information that reveals services obtained to that policy holder.

keepitconfidential birth control pregnancy test STD teen insurance pharmacy pharmacist

How can I make sure my insurance company keeps my health information confidential?

In California, a law was passed that allows dependents to fill out a Confidential Communications Request form to prevent insurance companies from sending potentially revealing information to the policy holder. Instead information specified in the form will be sent directly to the patient by either email or an alternate mailing address as requested by the dependent. More information for patients and providers can be found at myhealthmyinfo.org.

How can pharmacists help?

This is an important counseling point for pharmacists to review with patients.  Cost can become a big barrier to access when patients do not feel comfortable using their insurance and have to resort to paying out of pocket.  Since this is a new law, pharmacists can help spread the word and direct patients to the website for more information and the form.  Pharmacists should always be aware of their state laws regarding serving minors and confidentiality.


Courtney HeadshotAbout the Author:  

Courtney Miller is in her second year of pharmacy school at the University of California San Diego Skaggs School of Pharmacy & Pharmaceutical Sciences. 

Pill Supply…The Pharmacy is On Your Side

Birth control pills are the most popular form of hormonal birth control and one of the most popular forms among all birth control methods.Birth Control Pill Supply Choose Control Sally Rafie

What’s the problem?

One of the biggest barriers to using birth control pills correctly and consistently is the lack of supply. Many women find themselves out of birth control pills when they go to take their next pill.  And because birth control pills currently require a prescription from a doctor or clinic, this could lead to delays.  Catastrophic delays.  Missing a couple birth control pills is very different than missing a couple of cholesterol pills.  It could mean pregnancy.  Especially because the first few pills in each pack are the most important to take on time to be sure ovulation is prevented (and no egg is released).  So that explains the problem.

What’s the solution? 

Giving women larger supplies of their birth control pills!  This mean less trips to the pharmacy, fewer missed pills, and fewer unplanned pregnancies.  It’s all very logical.  The hang up?  Health insurance plans don’t want to pay for larger supplies up front.  From their perspective, you may be a customer this month, but may not be a few months from now.  More and more plans are restricting the supply that can be dispensed at the pharmacy.  So even if your prescription is written for a 3-month supply at a time, the pharmacy may only be able to give you 1 pack for no/low co-pay.  Of course, women can choose to ditch the reimbursement from their health insurance plan and pay cash for multiple packs at once, but few will choose to do that and they certainly shouldn’t have to.

What does the research tell us?

All the research supports larger supplies.  It helps women stick to their birth control method and we know that’s what it takes to prevent unplanned pregnancies.  A systematic review of four research studies found that prescribing and dispensing more pill packs led to a handful of benefits:

  1. Increased birth control method continuation
  2. Fewer pregnancy tests
  3. Fewer pregnancies
  4. Fewer abortions
  5. Lower cost per patient

The only downside?  Some pill packs were wasted.  The wastage was a result of some women who stopped using birth control pills before they ran out of supplies.  But that was a small price to pay to reap all the other rewards.  There was an overall financial savings to providing more pill packs.

How do we get women the supplies they need?

Oregon lawmakers are proposing a new bill that would require health plans to allow up to a 12-month supply of birth control pills to be dispensed at once.  If you’re in the area and want to get involved, you can participate in a local lobby day on March 25th.  Hopefully this Comprehensive Women’s Health Bill passes and serves as a precendent for other states. For now, it is up to each health insurance plan to determine how many packs they will allow women to receive at a once.

Women always have the option to self-pay to get around plan restrictions.  Some pharmacies offer auto-refill programs to help patients stay on track with their medications, so ask if your pharmacy offers this.