Shirlee Zerkel: Pill rationing by STRS

April 26, 2006

I have been doing some research about quantity limits on STRS medications. This is what I have found in the STRS Health Care Book for 2006. My book is for the basic plan but the drug lists are the same for both plans. In the past years if the drug had limits on quantities, this is what was stated above the entire list "In some cases it may be medically necessary for you to exceed the preset limits. In those instances, proper authorization is required. In such cases your doctor should initiate prior authorization by calling Caremark" Now in the 2006 Plan Book, Drug Limitations is divided into 2 sections.

The second section includes Hypnotics and Male Erectile dysfunction therapy medications. Above that section it reads:

"If you request that a prescription be filled for a drug listed below that is subject to quantity limitations, the prescription will be filled up to the preset limits. If additional quantities are needed, you will be responsible for the entire cost associated with the medication. Appeals for coverage of additional quantities will not be considered for the following medications."

That list includes Ambien, Ambien CR, Dalmane, Doral, Halcion, Lunesta, Prosom, Restoril, Sonata, Caverject, Cialis, Edex, Levitra, MUSE, Viagra. It appears that this was to start in 2006.

The new Medicare D, AARP plan also has limits on the drug Ambien, and Ambien CR, but I do not know what the extent of their limits are.

This STRS change was to be effective for 2006. I do not understand why the sudden enforcement in April not January. This information was found as I carefully read the STRS 2006 book. They did not really try to inform us of such changes. We seem to have to hunt for the ways that our benefits are reduced.

I feel that a special notice should be issued at the end of each year and included in the enrollment pack of information to all members who use the STRS insurance and drug program. This notice should include all the changes that members can expect to experience in the following year. The only notice that STRS gave us last year was the increase in premiums and that tier one drugs would be reduced by a small amount. I hear that premiums will probably really rise in 2007. Let's hope that the medical benefits do not decrease as well. Our small pensions can't stand more raising of premiums and reducing of benefits. Retirees have reached their limits of medical costs as well.

STRS staff increase in premiums is not nearly what ours is and their benefits far surpass ours. Their family plan premiums do not even come close to what we pay for our spouses alone. They even have free dental coverage and no deductible on their health insurance.

Shirlee Zerkel