A family has filed a lawsuit against Walgreens following its alleged negligence that led to the death of their 19-year-old girl. They argue the prescription could not be filled without express permission from her insurance carrier.
On June 7, the Massachusetts top court said that pharmacies owe a legal duty of care to their customers. Pharmacies must take reasonable steps to notify customers and their prescribing doctors of the need to seek authorization from their insurance companies every time they want a prescription refill.
Speaking to Bloomberg Law June 8, the family lawyer, Thomas M. Greene of Greene LLP had something to say. He says that this marks the first decision in the US to recognize a duty in the underlying circumstances. Walgreens refused to comment on the decision.
Why Is a Prior Notice Important?
Judge Barbara A. Lenk wrote for the court. Health insurance companies require that the prescribing doctors submit authorization forms that prove the medical importance of certain prescriptions and their cost-effectiveness,
Lawyer Greene argued that it’s vital to make sure the doctors are notified. He went on to add that a physician is the only one with the necessary qualifications to fill the prescription pre-authorization paperwork.
An advocacy group that represents the wellbeing of the Massachusetts low-income residents in need of proper health care agreed with Greene’s sentiments.
In a statement sent by its lawyer, Wells, G. Wilkinson, the Health Law Advocates in Boston argued. They asserted that the duty to share the said information with their customers’ physicians would help streamline the communication between professionals without leaving out the patients.
Additionally, the advocacy group filed a brief supporting the lawsuit filed by the family against the pharmacy.
The court said that prior authorization was crucial so Yarushka Rivera could obtain insurance coverage for the life-threatening seizure control medication, Topamax. Besides court added that Rivera couldn’t afford the medication without insurance meaning she didn’t take the medication months before suffering fatal seizures.
In a summary judgment for Walgreens, a trial court argued the pharmacy had no duty to notify Rivera’s physicians regarding the need to seek authorization for the prescription.
The Supreme Judicial Court Reversed the Trial Court’s Ruling
When reversing the initial ruling on the case, the supreme judicial court said the new notification duty is limited. That would mean the pharmacy was not under obligation to follow up on its own, confirm that the prescribing physician received a notification or had completed a prior notification form.
But Justice David A. Lowly differed asserting that majority imposed a ‘nebulous duty’ on drugstores to notify the prescribing physicians that authorization is required for particular medications to obtain insurance coverage.
The American Association of the Justice, the country’s largest plaintiff lawyers group, is in support of the family’s position.