Another nightmare we could ALL soon face: quantity limits on pills

I received the following communications from a retiree I taught with; a person who, like the rest of us, has always gone out of his way to follow the rules and do the right thing. Has anyone else had this experience? Could this be a sign of what's to come for all of us?

Kathie Bracy kbb47@aol.com

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April 20, 2006

STRS quietly implemented changes in prescription coverage on April 1. In the past they have imposed quantity limits on certain drugs unless the doctor submitted a letter stating the medical necessity to use the quantity that he/she prescribed. Now, the doctor has no say-so. STRS' new policy is we will tell you how many pills you can have. If your doctor thinks it is medically necessary to exceed that amount he/she can provide samples or the STRS member can pay for the additional pills out of their own pocket. Example: Ambien (sleep disorder medication) STRS says that you can only have 14 pills in a 28 day period. The doctor says that unless the medication is taken every night you will have problems sleeping.

I get it! STRS plan: if members only sleep every other day they will be too tired watch what we do and complain.

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April 23, 2006

I found out this past week. I have been on Ambien for a number of years. When I had the prescription filled in March it was filled for thirty as approved with the doctor's request to exceed the STRS limit of 14 per 28 days. Giant Eagle called and said when they tried to run through the 30 it was denied. I called Caremark and they informed me that they no longer allowed doctors to request increases due to medical necessity. They were almost rude about it. The girl said, “if you think you need a more pills than what your retirement system thinks is necessary, you can pay for them yourself.” I called my doctor and ask them to check into to it. They called back a day later and said that it was a fact. STRS/Caremark would no longer allow doctors to request and increase in number of pills or dosage even if the doctor thinks it is medically necessary.