New Medical Score Sparks Controversy, Questions

RA Guy Community News 17 Comments

Okay, when I first read this article I thought it was just someone’s idea of a bad joke…but it’s real!

Within the next 12 months, whether you like it or not, about 10 million Americans are expected to be scored — much like a credit score — on how likely they are to fill a prescription and take all the pills the doctor ordered, on schedule.

FICO, creator of the widely used credit score that predicts whether you’ll borrow responsibly, is now rolling out its new Medication Adherence Score.

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Can someone please tell me what the benefit of such a system is, from a patient’s point-of-view? The company states that “those who score low can be targeted for extra reminders and educational efforts, with the goal of making patients more likely to complete their prescribed regimens.” My $7 plastic pill reminder box from Walgreens seems to be doing a good enough job, thank you very much.

What won’t happen, FICO says, is your insurance taking a hit because of a low score. “No decision is being made as to whether someone is getting access to health care,” says Shellenberger. That’s because companies can’t use the Medication Adherence Score when deciding whether to provide health insurance and how much to charge for it. “The score was not designed, tested or validated to serve as an underwriting tool. And, underwriting is not an allowable use of the score under the terms of our client contracts,” Shellenberger says.

FICO declined a request for a copy of the contract. FICO says consumers can find out if they have scores by asking their health care providers.

As a commenter wrote, if such a score is not going to be used for insurance purposes, what exactly will it be used for? Is this program opt in? If it’s not, how will a person be able to opt out ? For me, there are just too many questions, and not enough answers, to be comfortable with this idea.

Do we really need more ways for insurers to “justify” their continually increasing denials of coverage?

Comments 17

  1. Katie

    It seems wrong to me and I have a feeling it will open the door to many problems. There are no guarrentees that insurance won’t use that score for themselves and just how public is this score going to be? Will employers see this score? Will it just be out there for everybody to see? I don’t see a valid use for it.

  2. Rising Phoenix

    I’m in the UK but this does sound bizarre. What is the purpose, as RA Guy has said, if not for insurance?

  3. Joe

    I see a foreshadowing of “1984” in this? Oh sure, they are “it’s illegal this and illegal that”…but give it a few years. Our costs of healthcare will be directed by this score as much as our availability to credit is by the other. Just wait and see…

  4. Post
    RA Guy

    I’m not buying the idea that this will be used for “reminders and educational” purposes.

    One of the three major credit rating agencies is now concerned about whether or not I’m taking my meds, so that they can send me reminders?

    As Apple would say, “There’s an app for that!”

    And putting aside the whole notion of equating buying medicines with taking medicines (they could just as easily sit on the counter after coming home from the pharmacy, as I’m sure they often do), my next question is: Who is FICO going to be selling this service to?

    Not consumers.

    Doctors, I doubt it.

    Insurance companies? Bingo.

  5. Cheri

    Each time I get a refill for my Cimzia injections through Prescription Solutions (United Healthcare), they ask me if I take what I am prescribed, do I stop taking my meds if I feel better, do I do what the dr tells me to do regarding taking my meds, etc. Are they nuts? Yes, I realize my injections cost about $2K a month, but what the heck??!!

  6. Bob

    So how about whenever i get sick(cold/flu)i have to stop takeing Enbril,and methotrexate?is that going to count ageinst me?

  7. Elisabeth

    My guess is if they see you not taking your meds but you don’t have significant pain etc. They will say you don’t need the meds. My doctor said they need to show 20% improvement for a med to be continually covered. If you have ever had to fill out a checklist about how you are feeling at your doctor that is the reason why. They will soon be required by most insurance companies.

  8. Jackie

    I worked in insurance for many years. I hate to be the one to tell you this, but if you have been in a group plan, your insurance company has been compiling compliance data since the 90’s, targeting age, gender & income groups. And it’s NOT because they are looking out for your best interests, even though it’s spun that way. Just my experience.

  9. Deb aka murphthesurf

    Hog Wash is all I can say! What a crock! Fool me once shame on you, fool me twice, shame on me. First time fooled….insurance companies use of our credit scores to assess rates. You are not fooling me twice.

  10. Laurie

    Insurance groups have indirect permission to view your medical reocrds as you have to sign a HIPPA acknowledgement with physicians and pharmacies.
    When my medication information goes to anyone other than my DIRECT insurance company, physician or pharmacy, that is a violation of my rights. I never signed anything letting FICO see my information.

  11. Natalie@noshingwithnatalie

    This is creepy and totally ridiculous. I have been in a cycle of adjustment with my meds, so some months I take all of my pills and some months I don’t. This is no one’s business but mine and my rheumys. Ridiculous!

  12. Carla

    I’m sure that they’ll look at insurance records to see if you refill your prescription every 30 days. This is just like I found my medical test scores posted to my Aetna account — after Aetna sent me an email with handy tips on how to control my triglyceride count …

    I agree that if they’re being asked to PAY for medications, they should be informed what those medications are and what condition they’re being used to treat. However, whether I take all my medication or not is between me and my doctor.

  13. Dr Karen Hoving

    I have to say, this is why the majority of shrinks don’t accept insurance any more. I quit when I realized that there is NO confidentiality any more. If I accept insurance (which most patients want bc of finances) they don’t realize that if they are diagnosed with Dysthymia (Depression) they can YEARS later be turned down for Life Insurance bc of being a “suicide risk!” I know in this economy people don’t have extra $ for therapy so I accept a sliding scale. I can only do this if I refuse insurance (or it is insurance fraud). The Insurance machine in the sky, as @Jackie said, is real and keeps tabs on everything! What you say to me is supposed to be confidential, except to someone on the other end of the phone line that wants ALL the dirty details of YOUR life. And trust me, it WILL come back to haunt you. This article is terrifying and as you have all picked up, NOT in your or my best interest. And I have enough pill containers to keep up with my meds, thank you very much. I don’t need my High Risk Pool doing it for me! Especially at what cost (Privacy, Financial). I know people are terrified about universal health but why is it we are the only country where people go bankrupt bc of being sick. The French seem to be doing just fine…and we have MORE Docs, drugs, hospitals, MRI’s, etc so the fear of waiting for procedures is BS.

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