Amazon’s online pharmacy is clashing with a company that collects health information, and it could have huge implications for the future of healthcare

Hollis Johnson/Business Insider

Amazon-owned online pharmacy PillPack is waging a battle with health-data company Surescripts over access to the prescription history data that Surescripts collects.
PillPack in July was reportedly considering suing Surescripts, according to CNBC. In turn, Surescripts said it reported a company PillPack was working with to the FBI.
The spat highlights a big fight over your private health information. The question is: who should have access to a patient’s prescription history.
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Amazon’s online pharmacy PillPack is now embroiled in a huge fight that has big implications for the future of healthcare.

In July, CNBC reported that PillPack was considering suing Surescripts, a company that collects and transmits data about prescription drugs from providers to pharmacies, arguing that it should have access to medication history data that Surescripts collects. In turn, Surescripts said it reported a company PillPack was working with to get access to Surescripts data to the FBI.

PillPack’s been known for pushing back against the way the pharmacy business is run. Prior to its acquisition by Amazon in June 2018, it got into a public argument with pharmacy benefit manager Express Scripts that almost resulted in PillPack getting cut from the PBM’s massive network.

Now with the backing of Amazon, PillPack especially has the healthcare industry at attention. At the time Amazon announced it was buying PillPack, the deal sent shockwaves through the industry and healthcare stocks tumbling. Most recently, healthcare giant CVS Health filed a lawsuit against a former employee hired by PillPack, in which CVS alleged that PillPack is competing with its services and coming after its clients.

The latest battle over patient medication histories gets to the heart of a key question facing the healthcare industry as it becomes increasingly digital and data-savvy, with disruptors like PillPack pressing the issue: Who should be allowed to have what patient data, when?

Amazon’s face-off with a health-data company

PillPackTensions between PillPack and Surescripts became public in mid-July, when CNBC reported that PillPack was thinking about suing Arlington, Virginia-based Surescripts.

PillPack mails prescriptions to people who take multiple medications, packaging them together based on dose. The company has pharmacies around the country that send out medications by mail.

To help with that, PillPack’s been working with a Des Moines, Iowa-based company called ReMy Health, which got access to Surescripts’ data and passed it along to PillPack so the company could have a full picture of the medications its patients were taking.

ReMy told Business Insider that it works with many data providers, including Surescripts, and a number of clients, including PillPack. In particular, the company said it works with organizations "through the final few miles of care delivery," which include pharmacies and doctors.

CNBC reported that PillPack had been informed in July that ReMy had been told by Surescripts that it would soon no longer be able to share that information with PillPack.

"PillPack does not have an agreement with Surescripts that in any way covers the use of this important Protected Health Information," Surescripts told CNBC at the time.

PillPack, for its part, thinks that that information is something it should have access to, and says patients give it permission to view their data.

"A pharmacist’s job is to perform interaction checks, drug utilization reviews, and provide other clinical services," Jacqui Miller, a spokeswoman for PillPack, told Business Insider in a statement. "To do this, pharmacists need a comprehensive understanding of the medications each customer is taking. That’s why customers authorize PillPack, as a healthcare provider, to assemble their medication history."

That’s where Surescripts’ database comes in handy. Because it works with providers to pass along prescriptions to pharmacies, it has access to that medication history. Surescripts works with 80% of US prescribers, giving it an unprecedented view of prescription data that PillPack wants access to.

"Given that Surescripts is, to our knowledge, the sole clearinghouse for medication history in the United States, the core question is whether Surescripts will allow customers to share their medication history with pharmacies and if not, why not?" Miller said in the statement.

Surescripts cut off ReMy’s access to its data

Surescripts on Monday cut off ReMy’s access to its data, saying ReMy was sharing the medication history information with a pharmacy. The company said it had reported the matter to the Federal Bureau of Investigations because it claims ReMy or its customers provided fraudulent information to Surescripts when requesting patient data.

According to Surescripts, passing medication information to PillPack, a pharmacy, wasn’t the type of healthcare provider it intended to allow ReMy to share that information with. The data, Surescripts said, is intended for doctors rather than pharmacists.

ReMy CEO Aaron Crittenden, for his part, called the claims "unfounded" and "false" in a statement to Business Insider on Thursday.

"ReMy Health operates in full alignment with our contracts and privacy law," Crittenden said. "We support patients facing some of the most complex and costly health challenges – expediting patient access to medicines by equipping patients and their care providers with essential medical and plan coverage information."

How prescription data is traditionally shared

Hollis Johnson/Business InsiderBy gathering medication histories via Surescripts, PillPack was accessing prescription data that usually isn’t accessible to pharmacies. A pharmacist in a retail setting like a drugstore typically can only see the prescriptions a patient is filling at her drugstore.

Traditionally, pharmacies are sent a prescription to fill from a doctor. The pharmacist and her team then dispense the medication to the patient. They can check with the patient’s pharmacy benefit manager to understand both what the patient will have to pay and whether the pills she’s taking will have any bad interactions with other drugs that patient’s on.

The pharmacy benefit manager, for their part, tend to have a more complete picture of members’ medication history. Large pharmacy chains can often share data from one pharmacy location to another, giving them more of a complete history, Peter Goldstein, a professor of pharmacy at Long Island University Brooklyn, told Business Insider.

There are also state databases that pharmacists can use to check if patients have been prescribed controlled substances.

Finally, Surescripts, because it connects doctors to pharmacists by transmitting prescription information, has a comprehensive medication history by virtue of sitting in the middle.

Goldstein said that most of the time, the information from the PBM is enough for pharmacists to do their job.

Similarly, transferring prescriptions tends to be something a patient has to facilitate, Goldstein said. Say a patient wants to bring a diabetes medication prescription over to Goldstein’s pharmacy. That patient would have to provide the medication name and dose and original pharmacy, and then Goldstein could call that pharmacy and ask for that prescription to be transferred over.

That is, a pharmacy like PillPack would have to have all that information on hand in addition from the patient before it could transfer the prescription over.

Pharmacy data raises big privacy concerns

In part, there’s a competitive reason, in that pharmacies don’t necessarily want to lose a patient’s business to a competitor. But Steve Moore, a pharmacist at Condo Pharmacy in Plattsburgh, New York, said there are privacy issues as well.

For instance, he’ll see cases where patients drive 30 miles away to get a sensitive prescription from his pharmacy rather than the one in their hometown. Between pharmacists and pharmacy technicians, there are a lot of people at community pharmacies who could have access to sensitive patient information the patient might not want them to have.

"There’s still privacy concerns and issues with a blanket, data-for-everybody type of approach," Moore said.

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