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National Pharmacy Benefit Manager to Strengthen How it Provides Language Assistance Services / Based on OCR Complaint by a Spanish-speaker

Tuesday, June 16, 2009

Spanish version:

National pharmacy benefit management company Medco will significantly improve access to its services for limited English proficient members in 2009, the U.S. Department of Health and Human Services (HHS) announced today.

As the nation’s largest mail-order pharmacy operation, Medco dispenses more than one hundred million prescriptions a year through the mail. Following an investigation of a complaint filed on behalf of a Spanish-speaking member with HHS’ Office for Civil Rights (OCR), Medco developed a multi-faceted plan to improve services to non-English speakers.

“These actions will significantly improve members’ ability to manage and make informed decisions about their own health care -- a critical objective under the federal law prohibiting discrimination based on national origin,” said Robinsue Frohboese, acting director of HHS’ Office for Civil Rights. “Industry action like this is needed to combat health care disparities and promote health care reform to improve access and delivery of quality health care for all. We hope and expect that others in the industry will follow Medco’s lead.”

In 2009, Medco’s efforts will focus first on the needs of Spanish-speaking members. In addition to expanding its pool of bilingual customer service representatives who speak Spanish, Medco will revise its systems to enhance its ability to route Spanish-speaking members who need help with prescription drug questions or problems directly to bilingual staff, including pharmacists where possible and appropriate. Medco will continue to use a telephonic interpreter service available for more than 150 other languages to communicate with other non-English speakers.

A critical improvement in Medco’s internal computer systems will flag language preference on an ongoing basis to aid effective communication with limited English proficient persons during member-Medco contact. Medco will work to implement this improved ability to identify and track individuals’ language preferences so that important written communications and outbound telephone calls are placed to members in their primary language. Medco will also review how best to notify limited English proficient members that language assistance services are available.

Medco has committed to developing an evaluation process with respect to interpreter competency. Staff at call centers and pharmacies expected to communicate directly with members in languages other than English will be assessed as to language proficiency, and those serving as interpreters will be assessed for interpreting competency. Medco will train all relevant staff on system changes intended to improve access to limited English proficient members, and will monitor the results of these efforts through periodic assessments.

“Consistent with our commitment to making medicine smarter, we value this opportunity to collaborate with HHS on initiatives that will help empower patients with information to improve their understanding and use of pharmacy benefits, and enable greater adherence to their physician’s prescribed therapy,” said Glenn Taylor, Medco’s group president of Key Accounts.

Under Title VI of the Civil Rights Act of 1964 and its implementing regulations, recipients of federal financial assistance are required to take reasonable steps to provide meaningful access to their programs by limited English proficient individuals who are eligible to receive their services.

A copy of Medco’s written commitments and OCR’s closure letter, along with more information about OCR’s enforcement of Title VI and other federal civil rights laws, can be found at

5/15/09- Medco comittment letter,

5/28/09- HHS OCR Closure Letter,, Excerpt from HHS letter:

"The complainant indicated that the affected party only speaks and reads Spanish. OCR learned that the affected party is a member of a specific health plan that has contracted with Medco to manage its prescription drug benefit. Under the plan covering the affected party, health plan members may use Medco's mail-order pharmacy and Medco's network of retail pharmacies. Medco administers the prescription drug claims of the health plan members. The complainant alleged that Medco discriminates against the affected party (and all LEP members) in a number of ways, including failing to translate important documents or telephone recordings. The complainant alleged that in certain circumstances, Medco calls LEP members and leaves voicemail messages only in English or sends written communications only in English which request that the LEP members take a certain action. According to the complainant, if an LEP member does not take action, because he/she did not understand the request, then this may result in Medco's cancelling the LEP member's prescription (re)fill request, which is particularly problematic for an individual trying to manage a chronic condition, such as high blood pressure."

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