Notice of Privacy Practices

Effective Date: June 2019

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

Uses and Disclosures of Protected Health Information (PHI)

Magellan Rx Pharmacy believes in protecting the privacy of your health information. We may use or disclose your Protected Health Information (PHI) only for very specific reasons. PHI is any information related to health that identifies an individual. This information can be electronic or in any other format. Different types of uses and disclosures of your PHI that we may make are listed and explained below. Note: An example is not given for every use or disclosure reason.

When disclosing or using PHI, we will use the least amount of information necessary or required by law. If we need to use or disclose your PHI in a way that is not generally described in this notice, we will contact you for your written permission before the proposed use or disclosure.

Types of Uses or Disclosures of PHI Treatment

We may use or disclose PHI about you to assist in providing treatment or services. Treatment means the provision, coordination, or management of health care and related services by one or more providers, including the following activities:

  • Coordinating health care or related services by a provider with a third party
  • Consultation between providers relating to a patient
  • The referral of a patient from one provider to another

For example, we may use information from your provider when we fill your prescription, or we may disclose some of your PHI when we provide clinical consultation to your doctor regarding possible interactions between medications.

Payment

We may use and disclose your PHI so that your treatment and services provided by us may be billed and payment collected. For example, we may submit information about you to your health plan or other claims payer so that we can be reimbursed for prescriptions provided to you, or to make sure your medication is included in your prescription benefit.

Healthcare Operations

We may use or disclose PHI to carry out healthcare operations that pertain to running a pharmacy. Examples of such healthcare operations include:

  • Activities to analyze trends relating to improving health or reducing healthcare costs (called population-based activities);
  • Case management and coordination of healthcare;
  • Quality assurance activities (including audits by third parties);
  • Contacting providers and patients with information about other forms of treatment.

We may use or disclose your PHI for these or other activities that fall under this definition, such as processing customer complaints or fraud detection and investigation.

Health Oversight Activities

We may disclose PHI to a health oversight agency for compliance activities authorized by law. These activities are necessary for the government to oversee the healthcare system, compliance of benefits programs, and compliance with civil rights laws. Disclosures may occur through audits, investigations, licensure or disciplinary actions or civil, administrative, or criminal proceedings.

Information Relating to the Treatment of Minors

Information relating to the treatment of minors will be kept private according to federal and state laws. Many states allow minors, after a certain age, to receive certain treatment or services without permission from their parents. We follow all applicable laws that apply to the confidentiality of treatment for minors.

Information Pertaining to Certain Types of Treatment/Services

Information pertaining to treatment or services for some sensitive conditions, such as substance abuse, mental health, and HIV, may be subject to more restrictive privacy protections under state or federal law. Uses and disclosures of such information may be limited or prohibited by such laws in your state. For more information about these kinds of federal and state law restrictions and how they may apply to our uses and disclosures of certain PHI, please contact our Privacy Officer as noted at the end of this document.

Health Related Benefits or Services

On occasion, we may use or disclose PHI for preventive treatment reasons. Our preventive programs meet nationally-recognized quality and preventive health standards.

Lawsuits and Disputes

We may disclose PHI in response to a subpoena or court order. We may also disclose PHI in response to legal cases that directly involve you or us. All other disclosures for lawsuits or investigations will be made only with your written permission.

Service Reminders

We may use or disclose PHI to remind you of upcoming refill timeframes or other services which pertain to you.

Treatment Alternatives

We may use or disclose PHI to let you know about other types of treatment or services that may be of interest to you. All such communications are handled in a manner that protects your privacy.

Release of Information to Family Members

In some cases, we may disclose limited information about you to someone who is directly involved in your care or the payment of your care, or who can make healthcare decisions on your behalf.

Release of Information to the Armed Forces

If you are or were previously a member of the armed forces, we will disclose your PHI to the armed forces as required by law. We may also disclose information as required by our contract with your armed forces health insurer, if applicable. We will only release the minimum amount of information needed to carry out the purpose of the use or disclosure.

Release of Information to Workers Compensation or Similar Programs

We will not disclose PHI to workers compensation programs or similar types of programs without your signed permission.

As Required or Permitted by Law for Public Safety

We will disclose PHI when required or permitted to do so by law for public safety reasons. Disclosures may be made to protect you from a serious threat to your health or safety or to protect the health or safety of another person. Disclosures may also be made when requested by federal officials for national security or intelligence activities, or for the protection of public officials. We will only release the minimum amount of information needed and will follow specific legal guidelines.

Government Security Clearances

We may disclose PHI when required by law for government security clearances. We will only release the minimum amount of information needed for the clearance.

Public Health Risks

We may disclose PHI as authorized or required by law for public health activities. This includes reporting child abuse or neglect, adult abuse, unfavorable events, or product defect reporting.

Inmates

If you are an inmate or in the custody of law enforcement, we may disclose your PHI without your permission. We will only do this for the health and safety of you or others, or for further law enforcement on the property of the correctional facility. Disclosures for other law enforcement purposes are limited and associated with reporting and assisting in the investigation of criminal activity.

Psychotherapy Notes

We rarely ask for psychotherapy notes and do not disclose them to any outside parties. Psychotherapy notes are defined as notes recorded by a mental health professional that consist of the written record or evaluation of the contents of a conversation during a private counseling session or a group, joint, or family counseling session. These notes must be maintained by your provider separately from the rest of your mental health/medical record. In the rare event that we do request psychotherapy notes, it will be only with your written permission.

Other Uses and Disclosures

Other uses and disclosures will be made only with your written authorization. For example, any uses or disclosures of PHI for marketing purposes or that constitute the sale of PHI requires your written permission. You are permitted to discontinue such authorization at any time in writing. Requests to discontinue permission to release your PHI will be honored except to the extent we have already taken action based on your prior permission to use or disclose the information. Also, while we do not use or disclose PHI for underwriting purposes, any health plans that do so are prohibited from using or disclosing any genetic information for underwriting purposes. Similarly, while we do not use or disclose PHI for fundraising purposes, any health plans that do so must furnish the opportunity to opt-out.

Rights Related to PHI

To exercise any of the rights described below, please contact us at:

Privacy Officer
6870 Shadowridge Drive, Suite 111
Orlando, FL 32812
800-915-2108

Right to Request Restrictions on Uses and Disclosures

You have a right to request limits on certain uses and disclosures of PHI for treatment, payment, or healthcare operations. We will consider each request, but we are not required to agree to any requested limits, except that we must agree to a request you make for us to not disclose PHI to your health plan about a healthcare item or service for which we have been paid in full out of pocket. In certain cases, limits set on the disclosure of PHI may affect our ability to provide services to you.

Right to Receive Confidential Communications

You have a right to request that you receive confidential information relating to PHI at an alternative location or by an alternate means if you do not wish to receive such information by normal means. All such requests must be in writing, and all reasonable requests will be granted.

Right to Inspect and Copy Protected Health Information

You have a right to review and ask for a copy of your PHI that is part of our designated record set. This right does not apply to: psychotherapy notes; information gathered to prepare for civil, criminal or administrative actions or proceedings; or where law does not permit the release.

There are also circumstances where we may deny your request. For example, there are situations in which a licensed healthcare professional may determine that releasing the information could have an adverse effect on you or another person. In such cases we will not release the information; however, we may be able to release some information in our records. We also will not release information that was created by your provider, such as a medical record, and you will need to contact your provider directly for that information. If allowed by your state law, we may charge a reasonable cost-based fee to copy, process and mail your information.

Right to Amend Protected Health Information

You have the right to request that we change the information that we have in our records if you believe that the information is incorrect or incomplete. We may deny this request if we determine that the records are complete and accurate, or that we did not create the information you are requesting to change. We may also deny the request if the information is not part of our official records or access is otherwise restricted by law.

Right to Receive an Accounting of Disclosures

You have a right to receive a listing of PHI disclosures that have been made other than (i) those made for treatment, payment or healthcare operations, (ii) those made prior to April 14, 2003, (iii) those made with your written permission, and (iv) those made for law enforcement or national security purposes. You also have the right to be notified in the event of a breach of your unsecured PHI, where “breach” means an unauthorized use or disclosure of PHI that compromises the security or privacy of the information.

Our Responsibilities under This Notice

The law requires us to maintain the privacy of your PHI. The law also requires us to provide you with this notice of our legal duties and privacy practices with respect to your PHI. We are required to follow the terms of the privacy notice that is currently in effect. We reserve the right to change the terms of this notice and to make the new notice provisions effective for all PHI that we maintain. Should the terms of this notice change in any way that would also change your rights, we will send you a notice of this change within 60 days.

Questions and Comments

Your opinion about our services is very important to us. We also want to make sure that you fully understand your privacy rights. If you want more information about Protected Health Information you can go to the U.S. Department of Health and Human Services HIPAA Privacy website at www.hhs.gov/ocr/privacy/hipaa/understanding/index.html.

If you have any questions or comments about our services, contact us at:

Privacy Officer
6870 Shadowridge Drive, Suite 111
Orlando, FL 32812
800-915-2108

Right to Obtain a Paper Copy of this Notice

You have a right to receive a paper copy of this notice, even if you have received a copy of this notice electronically. To request a paper copy, contact the Privacy Officer at the address listed above.

Complaints

You may file a complaint with us if you feel that your privacy rights have been violated. You will not receive a negative reaction from us because you filed a complaint. Contact us at 866-554-2673 or submit your complaint in writing:

Magellan Rx Pharmacy Quality Department
6870 Shadowridge Drive, Suite 111
Orlando, FL 32812
866-554-2673

You may also file a complaint with the US Department of Health and Human Services at www.hhs.gov/ocr/privacy/hipaa/complaints/index.html. Magellan Rx Pharmacy is accredited by the Accreditation Commission for Health Care (ACHC). You may also file a complaint with ACHC at 855-937-2242.