[liplady]

Is it a hippa violation for an employer to review their employee and spouse's medications and place the more expensive ones in a more costly co-payment tier?

[ScottGem]

First its HIPAA. Second, if I'm understanding you, then it probably isn't.

An employer generally does not do this. But their health care provider can. Health care insurers put out a formulary, that lists medications and what tier they fall into for reimbursement. Generally more expensive meds do go into a higher tier.

There is no HIPAA violation in this since, even if the employer is part of this decision, the info about what meds are being used is not revealed to an unauthorized third party.

There MIGHT be a case of discrimination, but its highly unlikely.

What makes you think your employer changed the formulary to target specific meds?

[liplady]

My first three-month prescription for a medication cost $60. When I refilled the prescription (mail order) they told me the cost would be $225. Our insurance company told me the increase was because the employer changed the tier to the higher one. Now I can't afford the medication. My husband, the employee, talked with other employees to find the same thing had happened to them. It just doesn't seem right that the employer can pick the medications being taken and increase the cost.

I do appreciate your response. Thank you in advance.

[ScottGem]

Do they pay part of your insurance premiums? If so, I think they they can influence the formulary. But this is not usual. I would contact your state's Department of Insurance about this.

But its not a HIPAA violation.