Rx Assistance 123 takes a strong interest in valuing our relationship with you. This is why we understand not only how respectful, but how strong privacy is to our relationship with you. With this said, we are committed to protecting the privacy of your Protected Health Information (PHI). Protected Health Information (PHI) includes any individually identifiable health information. Identifiable refers not only to data that is explicitly linked to a particular individual (that’s identified information), it also includes health information with data items which reasonably could be expected to allow individual identification.
We may obtain your PHI information for the sole purpose of helping with the service we offer and to document pertinent information in your records that may assist us in managing your involvement in our program as well as patient assistance programs that provide prescribed medications to you. Such use and disclosure may take place by providing, coordinating, or helping to obtain prescription medications for you by consulting with your pharmacist, physician, other specialist, or a representative of a pharmaceutical manufacturer. Such use and disclosure may also take place while conducting quality assessment and improvement reviews and/or training; reviews and compliance activities; and planning, developing, managing and administering the basis of our business, namely conducting a pharmaceutical assistance service.
We may use and disclose your PHI when we contact a physician or his or her staff or a representative of a pharmaceutical company to determine, process, or gather information necessary to complete applications for prescription assistance programs on your behalf.
We store some of your PHI in electronic computer files, both in our office and with a reputable records management company, and employ other precautions to safeguard the integrity of your PHI. In spite of these precautions, it is possible but unlikely that a computer crash or other technological failure could cause the loss of data. Reasonable safeguards are employed to protect your PHI stored on electronic media or in paper files within our office.
Rx Assistance 123 and its employees are informed of their responsibility to protect confidential customer information and are bound by these terms of service. We will also strive to ensure that the information concerning our customers is accurate. If you and/or our company become aware of any inaccuracies in our records received from the individual being assisted, we will take prompt action in correcting these errors. Rx Assistance 123 will not disclose your medical information for any other purpose without your written authorization.
You have the right to request restrictions on certain uses and disclosures of your medical information. Rx Assistance 123 is not required to agree with your requested restrictions.
We reserve the right to change the terms of this Notice, making any revision applicable to all the protected health information we maintain. If Company revises the terms of this Notice, it will post a revised notice at the Company and will make paper copies. Notice of Privacy Practice for Protected Health Information is available upon request.
We also would like applicants to understand that you can revoke this authorization at anytime by requesting so in writing. Here at Rx Assistance 123, we act independently of any pharmaceutical manufacturer and their assistance programs. Rx Assistance 123 serves to assist in the application process and does not make nor is authorized to make decisions about acceptance, denial, or the management of any individual manufacturers program. Rx Assistance 123 does not act as a dispensing pharmacy and is not responsible for prescription information contained in any application as provided by the patient or their prescribing physician. Please understand that Rx Assistance 123 and its employees do not provide medical advice. The use of our employee’s assistance and the use of our website is not a substitute for or supplement to advice from a pharmacist, doctor or other qualified medical professional.
You may cancel the service any time after enrollment with a minimum of 14 days notice in writing prior to the next billing cycle as banking systems require advance notice. For our patients’ protection, we would never want to cancel someone out of our program and stop processing their refills without written notification from the patient.
Please submit written cancellation notice including the patient’s address, telephone, last four of social security number (to verify we are cancelling the correct person), reason for cancelling, and the patient’s signature to Rx Assistance 123.
Because we care, we would not want you to pay for our service if we cannot save you money. Assuming all your provided information was complete and accurate, we will refund all of your payments if you do not qualify for the PAP programs that result in a savings for you. To request a full refund submit “all your denial letters” from the pharmaceutical companies involved within 120 days of the date of enrollment in our program to our address. Once received, abiding by the terms and conditions, we will then issue a full refund of enrollment fee and initial monthly service fee.
However, if you are dissatisfied with our initial set up with Rx Assistance 123, a refund can be issued without denial letters sent. If a cancellation letter is received within 14 days from the date the first payment is processed, Rx Assistance 123 will refund the initial monthly service fee without the requirement of denial letters. Initial paperwork sent to the patient by Rx Assistance 123 must be returned with the cancellation letter for refund to take place.
*Please understand Rx Assistance 123 is available in the assistance of appealing these denial letters from manufacturers*