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SJC Rules in Correa v. Schoeck: Pharmacies Have a (Limited) Duty to Notify Physicians About the Need for Prior Authorization

By Elisabeth J. Ryan

Back in January of this year, the Center for Health Policy and Law (of which PHLW is a part) signed onto an amicus brief in support of the appellant-plaintiff in the Massachusetts case of Correa v. Schoeck. On June 7, the SJC ruled in the plaintiff's favor, reversing the lower court's order of summary judgment for the defendant pharmacy.  The court held that a pharmacy has a "limited legal duty to take reasonable steps to notify both the patient and her prescribing physician of the need for prior authorization each time [she] tried to fill her prescription." 

The facts, as we said in our previous post on the case, were as follows: "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."

Notably, however, the court limited the duty to just one instance of notification per prescription fill attempt. It stated that "the pharmacy was not required to follow up on its own or ensure that the prescribing physician in fact received the notice or completed the prior authorization form."

The lawyer for the plaintiff (the late Yarushka's mother) stated that the SJC is the first court in the country to hold that a pharmacy has this duty to notify a doctor about needing authorization. The case will now proceed to trial (or settlement negotiations) on the wrongful death claim. 

Elisabeth Ryan