You Have the Right to:
1. Considerate and respectful care from your pharmacists and other healthcare professionals.
2. Receive complete and accurate information about the scope of services that Everwell Pharmacy will provide and specific limitations on those services.
3. Receive relevant, accurate, current and understandable information from your pharmacist concerning your treatment and/or drug therapy.
4. Receive complete and accurate information from your pharmacist regarding the reason for your treatment and/or drug therapy, the proper use and storage of prescribed medications and the possible adverse side effects and interactions with other drugs, supplements or foods.
5. Receive effective counseling and education from your pharmacists that empowers you to take an active role in your health condition and treatment decisions.
6. Make non-emergency decisions regarding your plan of care before and during treatment, as well as refuse any recommended treatment, therapy or plan of care after being informed of the consequences of refusing treatment, therapy or plan of care.
7. Expect that all prescribed medications you receive are safe, accurately dosed, effective and in useable condition, whether received from a physician, health clinic, retail pharmacy or mail-order pharmacy.
8. Expect that all records, communication, patient counseling by your pharmacists and all related discussions regarding your drug therapy, including its effects and side effects, are conducted in a manner that protects your privacy.
9. Confidentiality and privacy of all your patient information contained in your patient record and Protected Health Information, as described in Everwell Pharmacy’s Notice of Privacy Practices.
10. Receive appropriate care without discrimination in accordance with physician orders.
11. Be advised if a medication has been recalled at the consumer level.
12. Call Everwell Pharmacy with any privacy matters and ask for the Privacy Officer; or contact us through our website, www.Everwellrx.com.
13. Voice your grievances/complaints regarding treatment of care, lack of respect or to recommend changes in policy, personnel, or care/service without restraint, interference, coercion, discrimination, or reprisal, and have your grievances/complaints investigated.
14. Call Everwell Pharmacy with grievances/complaints about your medication and ask for the Compliance Officer, Pharmacist In Charge, or contact us through our website, www.Everwellrx.com
15. Expect that your personal data, including all contact information, is not released by pharmacists, pharmacies or insurance companies to another party to be used in soliciting the purchase of goods or services, whether or not the solicitation is related to your care.
16. Choose the pharmacist and pharmacy provider where your prescriptions are filled and to not be pressured or coerced into transferring your prescriptions to another pharmacy or mail-order service. However, some insurers may have mandatory benefit plans that require you to use a specific pharmacy if the insurance company is paying the drug cost.
17. Choose a health care provider, including choosing an attending physician, if applicable.
18. Receive, in advance of care/services being provided, complete oral and written explanations of charges for care, treatment, services and equipment, including the extent to which payment may be expected from Medicare, Medicaid, or any other third party payer, charges for which you may be responsible, and an explanation of all forms you are requested to sign.
19. Be advised of any change in Everwell Pharmacy’s plan of service before the change is made.
20. Receive information in a manner, format and/or language that you understand.
21. Have family members, as appropriate and as allowed by law, and with your authorization or the authorization of your personal representation, be involved in your care and treatment, and/or service decisions affecting you.
22. To request and receive complete up-to-date information relative to your condition, treatment, alternative treatments, risk of treatment or care plans.23. To know or ask how to access support from consumer advocates.
24. For pharmacy health and safety information to include patient’s rights and responsibilities.
25. Have one’s property and person treated with respect, consideration, and recognition of patient dignity and individuality. Be free from mistreatment, neglect, or verbal, mental, sexual, and physical abuse, including injuries of unknown source, and misappropriation of patient property. (DRX2-2B) (DRX2-3A)
26. Be advised on agency’s policies and procedures regarding the disclosure of clinical records.
27. Be fully informed of your responsibilities.
You Have the Responsibility to:
1. Give accurate clinical and contact information and to notify the pharmacy of changes in this information.
2. Adhere to the plan of treatment or service established by your physician or healthcare provider.
3. Ask questions about your care, treatment and/or services, or to have clarified any instructions provided by an Everwell Pharmacy representative.
4. Communicate any information, concerns and/or questions related to perceived risks in your services, and unexpected changes in your condition.5. Treat Everwell Pharmacy personnel with respect and dignity without discrimination as to color, religion, sex, creed, or national or ethnic origin.
6. Care for and safely use medications, supplies and/or equipment, according to instructions provided, for the purpose they were prescribed and only for/on the individual for whom they were prescribed.
7. Notify Everwell Pharmacy of any changes in your physical condition, physician’s prescription or insurance coverage. Notify Everwell Pharmacy immediately of any address or telephone changes whether temporary or permanent.
8. Pay all charges upon receipt of prescribed drugs.
Your Medicare rights
You have the right to request a coverage determination from your Medicare drug plan if you disagree with information provided by the pharmacy. You also have the right to request a special type of coverage determination called an “exception” if you believe:
• you need a drug that is not on your drug plan’s list of covered drugs. The list of covered drugs is called a “formulary;”
• a coverage rule (such as prior authorization or a quantity limit) should not apply to you for medical reasons; or
• you need to take a non-preferred drug and you want the plan to cover the drug at the preferred drug price.
What you need to do
You or your prescriber can contact your Medicare drug plan to ask for a coverage determination by calling the plan’s toll-free phone number on the back of your plan membership card, or by going to your plan’s website. You or your prescriber can request an expedited (24 hour) decision if your health could be seriously harmed by waiting up to 72 hours for a decision. Be ready to tell your Medicare drug plan:
1. The name of the prescription drug that was not filled. Include the dose and strength, if known.
2. The name of the pharmacy that attempted to fill your prescription.
3. The date you attempted to fill your prescription.
4. If you ask for an exception, your prescriber will need to provide your drug plan with a statement explaining why you need the off-formulary or non-preferred drug or why a coverage rule should not apply to you.
Your Medicare drug plan will provide you with a written decision. If coverage is not approved, the plan’s notice will explain why coverage was denied and how to request an appeal if you disagree with the plan’s decision.
Refer to your plan materials or call 1-800-Medicare for more information.
The following are a list of your rights in respect to your PHI. Request restrictions on certain uses and disclosures of your PHI: You have the right to request additional restrictions of the pharmacy’s uses and disclosures of your PH. The pharmacy is required to agreed to a request to restrict disclosure of PHI to a health plan if the disclosure is for the purpose of carrying out payment or health care operations and is not otherwise required by law, and if the PHI pertains solely to a health care item or service for which you have paid the pharmacy in full. Otherwise, you should be aware that the pharmacy may not be required to accommodate a request. If you wish to request additional restrictions, please obtain the form, Request for Restriction of Uses & Disclosures, from the pharmacy and return the completed form to the pharmacy or return to the Privacy Officer. You will be notified whether or not the Pharmacy will comply with the request for additional restrictions.
The right to have your PHI communicated to you by alternate means or locations: You have the right to request that the pharmacy communicate confidentially with you using an address or phone number other than your residence. However, state and federal laws require the pharmacy to have an accurate address and home phone number in case of emergencies. The pharmacy will consider all reasonable requests. If you wish to request a change in your communicating address and/or phone number, please obtain a form, Request for Alternative Arrangements for Confidential Communication, from the pharmacy and return the completed form to the pharmacy or return to the Privacy Officer.
The right to inspect and/or obtain a copy your PHI: You have the right to request access and/or obtain a copy of your PHI that is contained in the pharmacy for the duration the pharmacy maintains PHI about you. If you wish to inspect or obtain a copy of your PHI, please obtain a form, Request for Access to Records, from the pharmacy and return the completed form to the pharmacy or return to the Privacy Officer. There may be a reasonable cost-based charge for photocopying documents. You will be notified in advance of incurring such charges, if any.The right to amend your PHI: You have the right to request an amendment of the PHI the pharmacy maintains about you, if you feel that the PHI the pharmacy has maintained about you is incorrect or otherwise incomplete. Under certain circumstances we may deny your request for amendment. If we do deny the request, you will have the right to have the denial reviewed by someone we designate who was not involved in the initial review. You may also ask the Secretary, United States Department of Health and Human Services, or their appropriate designee, to review such a denial. If you wish to amend your PHI files, please obtain a form, Request for Amendment to PHI, from the pharmacy and return the completed form to the pharmacy or return to the Privacy Officer.
The right to receive an accounting of disclosures of your PHI: You have the right to receive an accounting of certain disclosures of your PHI made by the pharmacy.If you wish to receive an accounting of disclosures of your PHI, please obtain a form, Request for Accounting of Disclosures, from the pharmacy and return the completed form to the pharmacy or return to the Privacy Officer. You should be aware that such an accounting excludes uses and disclosures made for treatment, payment, or health care operations purposes.
The right to receive additional copies of the Pharmacy’s Notice of Privacy Practices: You have the right to receive additional paper copies of this Notice, upon request, even if you initially agreed to receive the Notice electronically. If you wish to receive a paper copy of this request, please ask a pharmacy workforce member and they will provide you with a copy.