NOTICE OF PRIVACY PRACTICES

Effective August 16, 2017

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.  PLEASE REVIEW IT CAREFULLY.

We Receive, Create or Maintain Your Protected Health Information Only with the Authorization of Your Health Plan or Pharmacist.

Each of our divisions, Pharmacy First and Third Party Station currently, serves as a business associate to one or more client health plans or pharmacies.  As a business associate, we receive, create or maintain your individually identifiable protected health information (“protected health information”) only with the authorization of your health plan or pharmacist.  Our use or disclosure of your protected health information also is limited by that authorization from your health plan or pharmacist and by law.  We use and disclose your individually identifiable protected health information only for treatment, payment and healthcare operations and those purposes allowed by law.  We provide services to our client health plans, plan sponsors and pharmacies consistent with the privacy policies received from them.  This notice applies to our uses and disclosures of your individually identifiable protected health information we receive, create or maintain in the absence of a privacy policy from one of our client health plans or pharmacies.

How We May Use or Disclose Your Protected Health Information.

Treatment and Healthcare Operations.

We may use or disclose your protected health information to provide you access to pharmacy or other treatment services or for operational purposes.  For example:

We may disclose your protected health information to doctors, pharmacists, nurses and other healthcare providers involved in your care and treatment and identify or recommend treatment options or alternatives.  We also may use and disclose your protected health information to contact your doctor or pharmacist about compliance with your drug therapy, refills, frequency of your medication, dosage and drug interactions.  We also may tell you and your doctor or other healthcare provider about health- related benefits, products or services under your health plan.

We may use and disclose your protected health information for purposes of contacting you about your prescription refills, compliance, drug administration, drug precautions and side effects and drug storage.

We may use and disclose your protected health information if you participate in a disease management program.

We may use and disclose your protected health information to provide you health information and reminders about upcoming appointments, to monitor your compliance with drug therapies and to assist in the coordination of your care with doctors and other healthcare providers.

We may use and disclose your protected health information as part of any therapeutic intervention authorized by your health plan or pharmacist.  We also may use and disclose your protected health information to contact your doctor or pharmacist about other drugs when a generic drug is appropriate or when a drug is not listed on your formulary or preferred or is not covered by your health plan or third party payor.

We may disclose your protected health information to members of our clinical staff, risk or quality improvement personnel, and others: (a) to evaluate our performance; (b) to learn how to improve our facilities and services; and (c) to determine how to improve the quality and effectiveness of the healthcare we provide.

We may use your protected health information to assess the quality of care and outcomes in your case and similar cases.

We may use and disclose your protected health information to provide utilization reports and other data analyses to your health plan or plan sponsor for purposes of prescription benefits management.  We also may use and disclose your protected health information to perform periodic quality assurance reviews and audits and to develop protocols or guidelines.

We may provide your protected health information to our internal (and external) auditors, attorneys, accountants, and other consultants for the purpose of complying with law.

We may use and disclose your protected health information in conducting data analysis for purposes of developing new programs and providing services to improve outcomes and manage prescription drug costs.

We may disclose your protected health information to a healthcare provider, health plan or clearinghouse for purposes of their healthcare operations.  We will only do so if they have or have had a relationship with you and if the protected health information they request pertains to that relationship.  In addition, we will disclose your protected health information to these third parties for limited purposes only, such as conducting quality improvement activities, reviewing the performance of a healthcare provider or training purposes.

Payment.

We may use and disclose your protected health information to others for purposes of receiving payment for treatment and services that you receive.  For example:

We may use your protected health information to bill your health plan or plan sponsor for the services we provide you.

We may use your protected health information to determine if you are eligible or enrolled for coverage or benefits under a health plan or other program.

We may disclose your protected health information to your health plan or plan sponsor for audit purposes or our business associates that perform billing, claim processing, claim review or appeals or other related services for us.

We may use and disclose your protected health information to obtain prior authorization of a drug that otherwise is not covered or is covered under limited circumstances.

We may use your protected health information during payment- related data processing.

Required by Law.

We may use and disclose information about you as required by law.  For example:

We may disclose your protected health information for judicial and administrative proceedings and to assist law enforcement officials in their law enforcement duties.  Such circumstances may arise:  (a) in response to a court order, subpoena or similar process; (b) in response to a request to identify or locate a suspect, fugitive, material witness or missing person; (c) in response to a request to provide information about a crime victim if, under certain limited circumstances, we are unable to obtain the person’s agreement; (d) about a death we believe may be due to criminal conduct; (e) about criminal conduct at one of our facilities; and (f) in emergency circumstances, to report a crime, our location or victims, or the identity, description or location of the person who committed the crime.

Abuse, Neglect or Domestic Violence.

We may use and disclose your protected health information to report information related to victims of abuse, neglect or domestic violence if required or allowed by law.

Public Health.

We may use and disclose your protected health information for public health activities such as assisting public health authorities or other legal authorities to prevent or control disease, injury, or disability, or for other health oversight activities.  Your protected health information may be disclosed to the U.S. Food and Drug Administration related to adverse events regarding drugs, drug products, recalls, defects and replacements.

Decedents.

We may use and disclose your protected health information to medical examiners, funeral directors or coroners to enable them to carry out their lawful duties.

Organ Donations and Transplants.

We may use and disclose your protected health information to assist in the donation of organs, tissues, bone and other body parts for transplant, research and other purposes allowed by law.

Research.

We may use and disclose your protected health information for research purposes when an institutional review board or privacy board that has reviewed the research proposal and established protocols to ensure the privacy of your health information has approved the research.

Health and Safety.

We may use and disclose your protected health information to avert a serious threat to the health or safety of you or any other person pursuant to applicable law.

Government Functions.

We may use and disclose your protected health information for specialized government functions such as protection of public officials or reporting to various branches of the armed services, intelligence and national security activities authorized by law or special investigations authorized by law.

Workers’ Compensation.

We may use and disclose your protected health information to comply with laws and regulations related to workers’ compensation or for you to obtain benefits for work- related injuries or illness.

Lawsuits and Disputes.

We may use and disclose your protected health information if you are involved in a lawsuit or dispute and we receive a subpoena or other lawful request.  We will make reasonable efforts to contact you about the request or perhaps to obtain a court order to protect your protected health information unless we receive your signed authorization to provide that information.

Minimum Necessary.

When using or disclosing your protected health information or when requesting your protected health information from a health plan or a health care provider that is not our client, we will make reasonable efforts to limit protected health information to the minimum necessary to accomplish the intended purpose of the use, disclosure, or request.  These limits do not apply in connection with: (a) disclosures to or requests by a health care provider for treatment; (b) uses or disclosures made to you; (c) uses or disclosures made pursuant to your written authorization; (d) disclosures made to the Secretary of the Department of Health and Human Services; (e) uses or disclosures required by law; or (f) uses or disclosures required for compliance with law.

Other Uses.

Other uses and disclosures will be made only with your written authorization, and you may revoke the authorization.  Your revocation will not apply to the extent: (a) we have taken action in reliance on your authorization; or (b) your authorization was obtained as a condition of obtaining insurance coverage and other law allows your insurance company to contest a claim under your insurance policy.

 

Your Protected Health Information Rights.

Request for Restrictions on Uses or Disclosures.

You have the right to request restrictions on certain uses and disclosures of your protected health information.  Any such request must be submitted in writing to our Privacy Officer at the address listed below.  We are not required to agree to your request.  If we agree, we will put it in writing and will abide by the agreement except when you require emergency treatment.

Request for Notice of Privacy Practices.

You have the right to obtain a paper copy of this notice upon request.  A copy of this notice may be obtained by contacting our Privacy Officer as described below or on our website at www.pharmacyfirst.com.

Inspection and Copying of Health Record.

You have the right to inspect and obtain a copy of your health record for which we may charge you in advance a reasonable cost-based fee and as allowed by law.  We will respond to your request within 30 days of receipt (or 60 days if the extra time is needed).  All requests should be directed to our Privacy Officer as described below.

Amendment of Health Record.

You have the right to request that your health record be amended if you believe that your protected health information we have is incomplete or incorrect.  Any such request must be made in writing and must be addressed to our Privacy Officer as described below and must tell us why you believe the amendment is appropriate.  We will not process your request if it is not in writing or does not tell us why you believe the amendment is appropriate.  We will act on your request within 60 days (or 90 days if the extra time is needed), and will inform you in writing as to whether the amendment will be made or denied.  We may deny your request if you ask us to amend information that:  (a) was not created by us, unless the person who created the information is no longer available to make the amendment; (b) is not part of your protected health information we keep; (c) is not part of the protected health information that you would be allowed to see or copy; or (d) is determined by us to be accurate and complete.  If we deny the request, we will tell you in writing how to submit a statement of disagreement or complaint, or to request inclusion of your original amendment request in your protected health information.

Request for Restrictions on Communications.

You have the right to request communications of your protected health information by alternate means or at alternate locations.  You have the right to ask that we send you information at a specific address (like your work address rather than your home address) or in a specific way (like email rather than mail).  If we are serving as a business associate to a pharmacist involved in your care or treatment, we will accommodate reasonable requests to do so.  If we are serving as a business associate to your health plan, we will accommodate such requests if they are reasonable and you clearly state that the disclosure of all or part of your protected health information could endanger you.

Accounting of Disclosures.

You have the right to receive an accounting of disclosures made of your protected health information as provided by law.  The list will not include disclosures made for treatment, payment, or healthcare operations purposes, directly to you or your family or friends, for disaster notification purposes, or pursuant to an authorization from you.  Nor will the list include disclosures made for national security or intelligence purposes or to law enforcement personnel or a health oversight agency, or disclosures made on behalf of a client health plan or pharmacist before April 14, 2003.  Your request for a list of disclosures must be made in writing and addressed to our Privacy Officer as described below.  We will respond to your request within 60 days (or 90 days if extra time is needed).  The list we provide will include disclosures made within the last six years unless you specify a shorter period. You will be charged our costs for providing any such lists.

 

Complaints.

You may complain to us and the Department of Health and Human Services if you believe your privacy rights have been violated.  You will not be retaliated against for filing a complaint.

 

Our Obligations.

Our client health plans and pharmacists are required by law to maintain the privacy of your protected health information and to provide you with a notice of their legal duties and privacy practices related to your protected health information.  Our client health plans and pharmacists are required to abide the terms of their notices of privacy practices.

We will maintain the privacy of your protected health information and abide by the terms of this notice.  We reserve the right to change our information practices and to make the new provisions effective for all protected health information we maintain.  If a change in our practice is material, we will revise this notice to reflect the change.  The revised notice will be mailed to you and made available on our website at www.pharmacyfirst.com.  You may obtain a copy of the revised notice by contacting our Privacy Officer as described below.

 

Contact Information.

If you have any questions or complaints, please contact our Privacy Officer at Wholesale Alliance LLC, 11880 College Boulevard, Suite 420, Overland Park, KS 66210.