Patient Rights and Responsibilities
Where We Stand:
The Academy of Managed Care Pharmacy (AMCP) recognizes and supports the concept that all patients (and their caregivers) should have certain healthcare rights that assure confidentiality of healthcare services,1 provide access to high quality healthcare, and allow access to information with which they may make informed decisions regarding their medication therapy and healthcare choices. However, inherent with these rights is the responsibility of each patient (or their caregiver) to become knowledgeable of his or her pharmacy benefit healthcare options, follow medical advice, and to implement lifestyle activities that promote optimal responses to prescription therapies.
Among those rights that should be afforded to all patients are:
- Patients have the right to be educated on the terms of their prescription drug benefit coverage. This information should be easily accessible by the patient.
- Patients have the right to have their individually identifiable prescription drug utilization information protected. This right does not prevent the use of patient-specific information for healthcare purposes, such as quality improvement purposes, peer review, disease management, mandatory reporting, adjudication of claims, or for use in adherence and compliance programs.2
- Patients with a pharmacy benefit have the right to access prescription services, regardless of sex, age, sexual orientation or preference, ethnicity, national origin, religion, genetic information, disability, disease state(s) or source of payment.
- Patients have the right to file complaints, grievances and appeals. Patients have the right to receive timely decisions, including expedited decisions for exigent circumstances, and explanations regarding prescription drug coverage limitations, including explanation of decision rationale and procedures for appealing decisions. However, the appeal process does not guarantee access to healthcare services that are excluded from the benefit that is purchased.
- Patients have the right to receive information to help them make the best use of their medications.
- Patients and their caregivers have the right to have information they or physicians submit on their behalf considered in coverage determinations and appeals.
Patients have the following responsibilities:
- Patients have the responsibility to become more informed about their drug therapy, including the limitations and risks.
- Patients have the responsibility to disclose to the prescriber and pharmacist relevant information that is necessary for appropriate selection of therapy options including; health status, lifestyle, current and past medications, and other medical and alternative therapies.
- Patients have the responsibility to implement lifestyle habits that complement safe and effective use of drug therapy. Examples include adherence to drug therapy, smoking cessation, and observance of dietary and alcohol limitations that may be necessary to achieve optimal drug benefit.
- Patients should respect the safety and privacy of other patients and healthcare professionals.
- Patients should comply with financial obligations, administrative and operational procedures of their pharmacy benefit, and report wrongdoing and suspected fraud, waste and abuse to the appropriate entities.
AMCP position statement on Patient Confidentiality and Appropriate Uses of Prescription Information by Managed Care Organizations
AMCP Where We Stand series: https://www.amcp.org/policy-advocacy/policy-advocacy-focus-areas/where-we-stand-position-statements
Revised by the AMCP Board of Directors, July 2016