Perhaps because in other states, pharmacies can already do this. No other state has the equivalent of California's Confidentiality of Medical Information Act, so there is nothing to prevent pharmacies from selling patient information. And they're selling that information, although not without controversy. Indeed, Adheris is still fighting a class-action lawsuit in Massachusetts for allegedly vioutf8g consumers' privacy through just this type of campaign.
But what about federal law? Doesn't the Health Insurance Portability and Accountability Act of 1996 (HIPAA) prevent this?
No. HIPAA was enacted by the Clinton administration to safeguard medical information. But according to Peter Swire, who was Clinton's chief privacy counselor and helped draft the legislation, the law permits pharmacies to contract with outside firms to engage in reminder campaigns. As originally drafted, the law included an opt-out. But the George W. Bush administration ditched it in 2002, weakening the law. Swire said Calderon's bill appeared to be an attempt to "shift California law to the federal standards."
Dan Rubin, CEO of Adheris, said California's strict law hurts patients. He cited a 2003 World Health Organization study suggesting that "increasing adherence [to prescription drug regimens] ... may have a far greater impact on patient health than any improvement in specific medical treatments." But to many in the health care community, the debate wasn't about whether adherence was a problem they all agreed it was but about how to best address it.
Dr. Jack Lewin, former CEO of the CMA and current chief of the American College of Cardiology, said that although patient compliance is a "critical" issue, Calderon's bill was a "Band-Aid solution." Lewin pointed out that non-adherence usually stems more from personal choice or denial than forgetfulness.
Dr. Sharon Levine, associate executive director of the Permanente Medical Group, said the problem with SB 1096 was that it was not "evidence-based."
"The science of non-adherence is in its infancy," she added. "We just don't know what kind of effect, if any, a mailed piece of information is going to have."
But thanks to Flanagan of Consumer Watchdog, among others, Californians won't need to worry about such mailings for now, anyway. When asked if the bill was dead for good, Flanagan warned of the need for continued vigilance. "It can always come back," he said, adding that a similar bill, AB 1587, is being presented to the Assembly Judiciary Committee this month.
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