The confidentiality of medical data is a growing concern of states looking at pharmaceutical marketing issues generally. Several states are considering bills to limit the transfer of prescription records containing data which identifies a patient, a doctor, or other health care professional licensed to prescribe medications if that data is used for marketing purposes. States are concerned that prescription records are used by those selling prescription drugs to give their marketers influence over prescribing practices in ways that subvert state interests in providing the best quality healthcare at reasonable costs.

Medicaid data containing certain types of information may only be disclosed or used for purposes directly related to the administration of the Medicaid program.  These legal restrictions require states to look at this source of health information differently than other sources.  The confidentiality of Medicaid data raises special legal issues because the program is governed by extensive and detailed federal law applicable specifically to the Medicaid program.   State Medicaid programs are also governed by HIPAA,   but the federal regulations governing state Medicaid agencies provide for more limited disclosure and uses of the data than allowed under HIPAA.

The primary focus of this memo is on the regulations that are applicable to state Medicaid administrators and those contracting with or assisting the state agency, not on privacy laws applicable to data available from CMS  nor on HIPAA requirements.

Full NLARx Policy Brief (181 KB MSWORD)