A 1998 incident in which patients' prescription information was used
to advertise a new drug exemplifies the importance of confidentiality in the
era of managed care and computers. The ethical concerns voiced about this
incident can also apply to pharmacy benefits management programs. The use
of personal health information in pharmacy benefits management is particularly
important because of increased pressures to control rising drug costs. Specific
confidentiality concerns include whether the goal of benefiting patients will
be achieved and whether the means are appropriate. The means may be problematic
because of financial conflicts of interest, lack of patient authorization,
inappropriate access to information by third parties, and inadequate safeguards
for confidentiality. Policies should be crafted that protect confidentiality
while allowing appropriate use of personal health information in pharmacy
benefits management. Sound policies should require clear evidence of benefit
to patients, an oversight committee, patient authorization, disclosure or
prohibition of conflicts of interest, additional safeguards for sensitive
medical conditions, strong confidentiality protections, and restrictions on
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