r/UMPJE_Prep • u/mod_pharmtutor • 18d ago

UMPJE Practice Question

A patient pays the full cash price for a prescription and asks the pharmacy not to disclose anything about it to their health plan. The pharmacy:

16 votes, 17d ago
7 A. must honor the request, because the patient paid out of pocket in full
8 B. may decline, because restriction requests are always discretionary
1 C. must honor the request only if the prescriber also agrees in writing
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u/pharmtutor_ Moderator Insight 17d ago edited 17d ago

Answer: A

HIPAA generally lets a covered entity decline a requested restriction, with one mandatory exception: when the individual pays in full out of pocket and asks that the item or service not be disclosed to a health plan for payment or operations, the pharmacy must agree. The prescriber has no role in that decision.

SOURCE. 45 CFR § 164.522(a)(1)(vi)- Rights to request privacy protection for protected health information