Insurance Firms Use Prescription Info To Screen Health Policy Applicants

Washington, D.C. (AHN) - Technology is making it possible for health insurance companies to evaluate personal drug profiles, culled from prescriptions, and decide if they want to issue a policy.

Milliman IntelliScript, provides insurance companies with personal drug profiles, culled from prescriptions, to help insurance companies evaluate applicants.

The resulting report could be compared to a health credit record, usually obtained by insurance companies from doctors' clinics.

Consumer advocates, however, are concerned that sourcing of health data may breach privacy when done without the supervision of federal health regulators and legislators. However, Milliman and another company which offers similar services, Ingenix, said consumer authorization is needed before data can be released.

When an insurance company inquires online about an applicant, the servers of the two firms search and within minutes can provide vital information going back five years. Data provided includes drugs, dosages prescribed, dates filled and refilled, and the name and address of the physician.

From that data a pharmacy risk score is determined. Milliman uses color codes to indicate applicant risk. A red code indicates the applicant has been prescribed AIDS cocktail drugs or cancer medication. Each profile search costs the insurance firm $15. Milliman receives at least 1 million requests a year.

Meanwhile, in Sacramento, the Governor's Office and the legislature are working to amend California's health insurance system. Among the features of the revisions being hammered by the state are limiting the insurer's profits on individual plans, mandating a minimum set of benefits for health policies and placing restrictions on insurance company's power to cancel policies retroactively.

According to Michael Russo, healthcare advocate of the California Public Interest Research Group, quoted by the Los Angeles Times, "The individual market really is the worst place to buy insurance... People can't band together to take advantage of greater bargaining powers in groups, and as a result of that, they pay more to get less."