Florida’s insurance coverage regulator has demanded an unusually intrusive trove of information on hundreds of thousands of prescribed drugs stuffed within the state final 12 months, together with the names of sufferers taking the medicines, their dates of beginning and medical doctors they’ve seen.
The Florida Workplace of Insurance coverage Regulation in January sought this info from pharmacy profit managers like UnitedHealth’s Optum Rx and CVS Well being’s Caremark, corporations that oversee prescribed drugs for employers and authorities applications.
It remained unclear why the state was ordering the submission of a lot information. In a letter to at least one profit supervisor reviewed by The New York Occasions, the regulator mentioned the state required the info to evaluate whether or not the profit managers, generally known as P.B.M.s, had been compliant with a 2023 state legislation aimed toward reducing drug costs and reining within the managers.
However the demand is sparking considerations about authorities overreach and affected person privateness.
“You don’t want such granular affected person info for functions of oversight,” mentioned Sharona Hoffman, a well being legislation and privateness professional at Case Western Reserve College. She added: “You must fear: Is the federal government truly attempting to get details about reproductive care or transgender care or psychological well being care?”
Florida’s six-week abortion ban, enacted by Gov. Ron DeSantis, a Republican, and the state’s Republican-dominated legislature, requires that medical doctors who prescribe abortion drugs dispense them in individual, not by way of the mail. One other Florida legislation banned transgender transition take care of minors and made it tougher for adults to hunt such care. Final 12 months, a choose struck down key elements of that legislation, although it’s nonetheless being enforced whereas the authorized combat makes its method by way of the courts.
The info requested by the state might, in principle, be used to find out whether or not physicians are complying with these legal guidelines.
It was additionally unclear whether or not any of the profit managers had complied and turned over the data to the state.
Some profit managers and the employers that rent them to deal with prescription drug advantages for his or her employees have additionally criticized the state’s demand.
A gaggle of huge employers, the American Advantages Council, is asking the Florida regulator to withdraw its order to show over the data. In a letter to the state, the council’s legal professionals wrote that the “demand impermissibly violates the well being privateness and safety of hundreds of thousands of Floridians,” and that the state had not clearly outlined its authority or causes for the motion.
“We have now an obligation to workers and their information,” Katy Johnson, the president of the council, mentioned in an interview.
Shiloh Elliott, a spokeswoman for Florida’s insurance coverage regulator, mentioned that objections to the state’s information request “are clearly from those that don’t wish to be regulated or have any oversight of their business.” She mentioned the workplace “will proceed to request information in the perfect curiosity to guard customers.”
Rosa Novo, the executive advantages director for Miami-Dade County Public Faculties, which offers well being protection to about 45,000 folks, mentioned in an interview that whereas she appreciated the state’s efforts to deal with drug costs, it was unclear why it might want this stage of detailed details about sufferers and their medicines.
“My physician is the one one who ought to know that,” Ms. Novo mentioned.
Federal privateness legislation permits profit managers at hand over restricted information about particular person sufferers in sure circumstances, comparable to when regulators are conducting an audit. However, based on consultants, Florida’s information request might violate the legislation as a result of it’s so broad and will transcend what the regulator must conduct its evaluate.
Specialists mentioned that one other concern with Florida’s request is that when delicate affected person information is in a number of arms, it raises the chance of a breach wherein the data could also be stolen.
Ms. Elliott, the spokeswoman for the regulator, mentioned these considerations “ought to be addressed to the precise well being care insurance coverage corporations which have had numerous information breaches exposing hundreds of thousands of People’ delicate info.”
Florida’s information order was first reported by Bloomberg.
Like different states, Florida already has entry to a few of the information it’s in search of, comparable to detailed details about prescriptions which might be paid by way of Medicaid. However that information is mostly strictly walled off, accessible solely to workers members whose jobs require it.
Profit managers usually area requests from authorities regulators asking for slices of information to conduct audits or investigations. Such requests sometimes ask profit managers to strip out affected person names, and different figuring out particulars, or ask for a small pattern of affected person claims.
By comparability, Florida’s information request was “fairly expansive and unprecedented,” mentioned Joseph Shields, the president of a gaggle of smaller profit managers, Transparency-Rx.
Florida sought information not solely on Florida residents, but additionally on sufferers who could have stuffed a prescription whereas visiting the state. Its request included sufferers coated by way of the federal Medicare program and industrial plans by way of employers which might be regulated underneath federal legislation fairly than state legislation, based on the regulator’s letter to at least one profit supervisor reviewed by The Occasions.
The Prescription Drug Reform Act, the Florida legislation the regulator used to justify the info request, imposed new reporting necessities on the profit managers however mentioned nothing a few mandate requiring them to show over such detailed affected person info. Profit managers have fiercely fought efforts to scrutinize their enterprise practices.
Florida’s information request was first reported by Bloomberg.
Patricia Mazzei contributed reporting from Florida.
