PBMs Invade Medical Records and Cash-Pay RX Discount Cards

We wrap up 2017 with a guest post from friend of IP4PI Barbara Duck (@MedicalQuack):

This should not really come as a big surprise as what hasn’t the pharmacy benefit managment business touched?  So what is OptimizeRX?  Most have probably not heard of this software but it is a connect to EMRs that will send your prescription right to the pharmacy.  Oh, now you say, well imagethe PBMs do that and they do but what they have been missing is a way to collect data on patients who are not using their PBM prescription card or those who do not have one.  It’s all about getting more data about you to “score” and of course sell those scores to insurers and other interested parties.  Once the pharmacy has the transaction, it does not fall under HIPAA rules as it’s a prescription, linked to an EMR to provide a transaction.  As we all know, your medications in an EHR are protected but again, I’ll repeat this for those who still think HIPAA is covered at the pharmacy, it is not.  It’s been a sore spot for years with privacy.If your doctor is using one of the medical records systems in the image at the right, they are partners with OptimizerRX.  From the website:

“OptimizeRx® has developed an extensive network of EHR and eRx platform partners*, as well as partnerships with media and creative agencies, making it easy for marketers to achieve excellent reach with their HCP customers. View the partner network information below for details. EHR and eRx partners benefit from the partnership by adding OptimizeRx’s suite of services seamlessly into their platforms, providing relevant patient support, patient education and other services that are welcomed by their HCP customers. Integrating OptimizeRx into an EHR or eRx platform is simple and easy, and can usually be completed in less than eight hours!” 

imageDid you catch this, it’s about marketing and at least they say as much.  When you look at the executive page, you’ll find most of these folks came from the pharmaceutical business.  Here’s another screenshot to “auto send” the prescription along with the RX pricing information direct to a pharmacy.  What this means is the price is locked in and a pharmacist has to honor that as it’s aready in the data base, precluding the availability to offer a cheaper discount.  Certainly it appears to make it easier for the patient, but is it the best price?  We don’t know.  In addition, the providers can print a coupon for those who say “no, don’t do that’.

This RX discount card also can text and email you.  So there you go, it’s all about the data that drug companies and PBMs want on folks not using their PBM discounts.  If you let the MD do the auto send, you’re stuck with that price and can’t compare.  There’s this little item I wrote about a while back about medication adherence prediction compliance and if you are not aware of this game, read the link below and this has been around for a while and was originally created with Ingenix (OptumRX now) algorithms that goes back to 2010 when Express Scripts put out a press release on how they were going to score you, and they all do that now.  This is some real flawed information too as the 300 metrics used have zero to do with taking meds.  You get a bad nick for example if you are a male seeing a female MD and so on.  This is not science, it’s behavior bullshit that at best may show trending.  So this OptimizerRX is software to use the EMR to drag in the so called “Outliers” who pay cash and are not using a PBM discount.  Part of the job of a pharmacist today is to identify their outliers and fix them, but if the data is flawed and they pay cash, it’s just a bunch of flawed data.imageSo now we have talked about OptimizeRX (which just happens to sound a lot like OptumRX) let’s move to the next step here and talk about the discount card.  Read the press release below, OptimizeRX has a partner called SingleCare, which actually resembles the HealthAllies company that Andy Slavitt and Senator’s Warren’s daughter sold to United Healthcare, except this one is free.  SingleCare includes other available discounts, a few of them but hey well all know it’s about getting the pharma PBM money to support the entire project, not a 20% discount at a gym or free teeth cleaning.

OptimizeRx Partners Exclusively with SingleCare to Bring Patient Savings and Price Transparency to Healthcare Providers at the Point of Prescribe

SingleCare started out much like Script Relief (another RX discount card that markets under a ton of names run by Loeb Enterprises in New York) to get some users of the discount so they could collect money from the PBM.  All the Script Relief cards make their money back from OptumRX on the fees and other charges and they pay independent sales people $10 a hit for every patient who activates a card.  Script Relief was originally connected with Catatmaran, which was bought by OptumRX (United Healthcare) and played a big role with Cigna getting sanctioned by CMS for a long time from selling Medicare D policies.  Here’s a couple archived links on tha topic and once the OptumRx purchased Catamaran, who was the in-house PBM for Cigna, all insured had a new PBM called United Healthcare (OptumRX) PBM.

So what kind of executives does SingleCare employ?  Well you could probably guess this one easyimage enough, former United Healthcare and big time former Catamaran executives.  Check it out.  In addition the company also says it will bill patients who use their discounted MD, dental cleaning, etc. services.  Yikes as a patient, I would much rather pay the doctor direct and not have some big corporate conglomerate chasing me who also wants my data to score and sell.  Many MDs have already figured out how these virtual credit cards hit them up for big fees anyway, so they keep part of that money for giving you a discount.

So what PBM do you think is supporting this?  My guess would be OptumRX but you can’t find that stated anywhere, but hey put two and two together.  So if you use the card, you are added to a PBM data base with data to score and sell and again, we think it’s OptumRX.  If you noticed above, Allscripts is one of the partners and is it not a coincidence that all OptumCare MDs are required to use Allscripts?  Here’s more on that topic along with a picture I snapped of one of their OptumCare owned MDs in the OC.  Don’t forget too that all the Surgical Care Affiliate outpatient surgery facilities are now owned and will be run by OptumCare, so I might guess Allscripts will be over there too, or OptimizeRX will sign up more EHRs to bring in the SingleCare discount card over there too.

We also have this action going on relative to OptumRX and Catamaran with lawsuits being filed over the price of prescriptions when a cash offering is less expensive than what the PBM is offering.

Bottom line here is to get the algorithms connected to the EHRs now and get that price locked in and get the data from the folks who are not using a PBM price.

Also the MedExpress urgent care locations are also connected to, guess who, OptumRX and you might be seeing those SingleCare RX discount cards used there as well.  United Healthcare also has another service they market where they want to be the EHR integrator for Allscripts and other medical record companies.

How convenient to be an EHR integrator and get that OptimizeRX connected in there to the medical records to promote the SingleCare discounts and collect data on folks who are not using their PBM program or are paying cash.  By the way too, Optum is also now doing the billing for Quest Labs in case you missed that one.  Optum does the billing of course for their very close partner, the Mayo clinic, who’s CEO just took a board seat with Merck Pharmaceutical.  Are you seeing some kind of a pattern yet, maybe?  Of course if you are insured by United, you have been told to go to LabCorp for years for actual tests.

The prescription discount game is heating up out there and Express Scripts doesn’t want to be left out as they too now have an RX discount card, called Inside RX which is a partnership with GoodRX, as they too didn’t want to get left out of the lucrative “fee” business here.  Sounds like imageOptumRX was cutting them out of some of the money mabye, so off to Express Scripts they went.

Here’s a post I did a while back with some good videos from actual independent pharmacists that tell you the story on how the RX discount cards work and how a lot of time they might still be able to give you a better cash price that doesn’t support all this markeing.

The Truth About Pharmacy Benefit Managers and Prescription Discount Cards–Created With Automated Algorithmic Processes That Enable Huge Profits-Consumers at Risk!

So backon topic here with SingleCare benefits, be aware of what’s going on with the algorithms of the PBMs as they are now invading medical records to get that script and and that data about you.  I would be very careful about wanting to use any of the texting and email services they offer as they collect and monitor everything today and will “score” your behavior with their services to toss some kind of risk in a profile about you!  Recently, VC arm of Optum/United Healthcare invested money in another cesspool Silicon Valley risk assessment company, Mindstrong to monitor people with cell phone behavior and when they get done scoring all that type of data, we’ll all be at risk for mental health issues if we “hesitate” on responding to text messages.

So be aware now as the PBMs have infiltrated medical records and stalking you there, with going beyond just regular PBM plans, they want to get data on everyone who pays cash to “score” and sell a data profile about you and your behavior.  Once you get locked with with your doctor doing an automatic send to the pharmacy, the pharmacist may not be able to offer you a less expensive price if they have one to offer on your medication.  BD

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