HIPAA Agreement and Release
Release to Disclose Protected Health Information
Plan Sponsors must complete this form to allow Express Scripts to transfer claims data. For example, to a Disease Management vendor, broker or consultant.
Business Associate Agreement
To our valued clients:
As you are well aware, the Health Insurance Portability and Accountability Act (HIPAA) requires that all entities involved in the delivery and payment of health care services comply with certain requirements under 45 CFR Parts 160, 162 and 164 relating to medical records privacy, security and electronic transaction standards.
It is generally understood that our health plan clients, whether HMOs, employers or insurers, are Covered Entities. This requires clients to enter into a "Business Associate Agreement" with Express Scripts, which is a Business Associate in some instances and a Covered Entity when service is provided through our mail service pharmacy subsidiaries.
Accordingly, in order to facilitate obtaining a Business Associate Agreement from Express Scripts, you may download a signed Business Associate Agreement Form. If your contract with Express Scripts already includes "business associate" provisions, then you do not need to proceed with this form.
Our goal was to develop a form that 1) would stand alone yet conform to the majority of existing agreements that Express Scripts has with its clients; and 2) would track the HIPAA privacy, security and transaction requirements as closely as possible and as applicable to the PBM arrangement that you have with us.
If your current Business Associate Agreement with Express Scripts does not include the security provisions, you may download a straightforward Security Business Associate Addendum, already signed by an officer of Express Scripts.
Please print the applicable form and have it executed and forwarded to your Express Scripts account manager.