HIPAA in Pharmacy
HIPAA (Health Insurance Portability and Accountability Act) in pharmacy governs the protection of patients' protected health information (PHI) during prescription processing, counseling, insurance claims, and all pharmacy operations.
Exam Tip
HIPAA permits disclosure for treatment, payment, and operations WITHOUT patient authorization. Know PHI examples and that technicians must protect patient information at all times on the ExCPT.
What Is HIPAA in Pharmacy?
HIPAA (1996) established national standards for protecting patient health information. In pharmacy settings, HIPAA affects how technicians and pharmacists handle prescription records, communicate with patients, and share information with other healthcare providers and insurers.
Key HIPAA Rules for Pharmacy
| Rule | Description |
|---|---|
| Privacy Rule | Establishes standards for who can access PHI and under what circumstances |
| Security Rule | Requires safeguards for electronic PHI (ePHI) including administrative, physical, and technical protections |
| Transaction Rule | Standardizes electronic claim formats (NCPDP for pharmacy claims) |
| Breach Notification Rule | Requires notification if unsecured PHI is compromised |
Protected Health Information (PHI) in Pharmacy
| PHI Examples | Non-PHI Examples |
|---|---|
| Patient name + prescription | De-identified aggregate data |
| Date of birth + medication | Drug pricing information |
| Insurance ID + diagnosis | General pharmacy policies |
| Address + refill history | Non-patient-specific drug information |
Permitted Disclosures Without Patient Authorization
| Situation | Example |
|---|---|
| Treatment | Sharing medication list with patient's physician |
| Payment | Submitting claims to insurance |
| Healthcare operations | Quality assurance, fraud detection |
| Required by law | Controlled substance reporting, board of pharmacy inquiries |
| Public health | Adverse event reporting to FDA |
Pharmacy Technician HIPAA Responsibilities
- Never discuss patient information where others can overhear
- Verify patient identity before releasing prescriptions
- Position computer screens away from public view
- Properly dispose of PHI (shredding, secure containers)
- Do not access patient records unless needed for job duties
- Report any suspected breaches to the pharmacist
HIPAA Violations and Penalties
| Tier | Violation Level | Penalty per Violation |
|---|---|---|
| 1 | Unknowing | $100 - $50,000 |
| 2 | Reasonable cause | $1,000 - $50,000 |
| 3 | Willful neglect (corrected) | $10,000 - $50,000 |
| 4 | Willful neglect (not corrected) | $50,000+ (criminal possible) |
Exam Alert
HIPAA falls under the Overview and Laws/Regulations domain (25% of ExCPT). Know the difference between permitted disclosures (treatment, payment, operations) and those requiring patient authorization. Understand that pharmacy technicians must protect PHI at all times.
Study This Term In
Related Terms
OBRA-90 (Omnibus Budget Reconciliation Act of 1990)
OBRA-90 is a federal law that mandated prospective drug utilization review (DUR), patient counseling by pharmacists, and maintenance of patient medication profiles for all Medicaid prescription recipients.
Controlled Substance Schedules
Controlled substance schedules are the DEA's five-tier classification system (Schedule I through Schedule V) that categorizes drugs based on their accepted medical use, abuse potential, and likelihood of causing dependence.
Adjudication (Pharmacy)
Adjudication is the real-time electronic process by which a pharmacy submits a prescription claim to a patient's insurance plan and receives an immediate approval, rejection, or request for additional information.
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