Center for Health Policy and Law Joins Amicus Brief in Correa v. Schoeck
Public Health Law Watch works in collaboration with the Northeastern University School of Law Center for Health Policy and Law. The Center has signed on to an amicus brief, in support of the appellant-plaintiff, in the Massachusetts Supreme Judicial Court case of Correa v. Schoeck and Walgreens.
The amicus brief is available here: Correa v. Schoeck, amicus brief
The issue in this case is "whether a pharmacy owes a duty of care to its customer to notify her physician that her insurer will not pay for her prescription medication without prior authorization."
Yarushka Correa was 19-year-old young woman who had recently been diagnosed with epilepsy after suffering a grand mal seizure. Doctors placed her on Topamax, which effectively controlled her seizures. However, her insurance company required that physicians obtain prior authorization before prescribing Topamax. Obtaining such authorization is a relatively routine paperwork process, yet it was never completed in this case. As a result, Walgreens would not dispense the medication and Yarushka was unable to fill her prescription for three months, despite going to Walgreens five times in an attempt to do so. In the normal course of business, and as promised to Yarushka and her mother, pharmacy employees contact the physician to notify of the need for prior authorization. No one at the pharmacy ever did that. Without her medication, Yarushka died after a grand mal seizure.
In the resulting wrongful death case, Walgreens argued that it owed no legal duty to Yarushka to inform her physician of the need for prior authorization before it would dispense her prescription. The Superior Court agreed and granted summary judgment to the pharmacy. Yarushka’s family appealed.
The amicus brief emphasizes that public policy dictates that pharmacy does, in fact, owe such a legal duty to patients. When a pharmacy fails to inform a prescribing physician that prior authorization is required by an insurance company, it denies patients’ access to necessary medications, which can lead to harm and (as in this case) even death. "Further, the pharmacy is not just the retail seller of a product, it is an essential part of the health care delivery system, far better equipped than the consumer, who is often vulnerable and in urgent need of medication, to understand and communicate to the physician about insurance payment denials for lack of [prior authorization]."
The case is scheduled for oral argument in the SJC on February 6, 2018.