Shirlee Zerkel and Gary Russell: Questions concerning CareMark

From Gary Russell, September 21, 2006

Subject: RE: Questions concerning CareMark

Dear Ms. Zerkel

STRS Ohio’s contractual standards with Caremark, which Caremark consistently meets, is that 95% of prescriptions are filled within 2 days. For exception drugs, those that require prior authorization or a call to a physician, the standard is 97% within 7 days. From your question I’d have to assume that the drug was one that either required prior authorization, a call to the physician or some other type of special handling.

Regarding Flogard, there is no such drug, perhaps the retiree gave you the incorrect name. If the retiree would like to contact me, I’d be happy to answer any questions about the pricing. In order to make an accurate comparison it is important that I know the quantity as well as the dosage of the medication. That being said, we negotiate for the best price to STRS Ohio for the total drug mix that we purchase. There will be some drugs that can be purchased cheaper at a retail setting. For example, a retail store may use a particular drug as a loss leader.

If you can ask the member to call me at 1-888-227-7877 or e-mail me at Russellg@strsoh.org, I’d be happy to resolve any concerns the member may have.

Thanks

Gary

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From: Shirlee Zerkel, Thursday, September 21, 2006

Subject: Questions concerning CareMark

Dear Ms. Knoesel and Mr. Russell:

I have two questions concerning the services of CareMark. First, a member ordered several medications by phone. Well over a week passed so the member called CareMark to inquire about the much needed medication. A CareMark employee told him that it had just been mailed out that day, and that CareMark's contract with STRS stated that they did not have to process orders until one week from the day the order was received. Is this true? And if so, why?

Second, Under what tier does the drug, Flogard, fit, and why is CareMark so much higher on the price than retail pharmacies? CareMark charged $46 for 90 pills and a local pharmacy charged $16 for 60 pills. That member could buy 120 pills from the local pharm for $32 and well after this incident. CareMark's price is almost double in per pill cost. Yet your recent flyer about Health Care News states that even with the higher co-pays " STRS members still receive a cost savings when they receive their drugs through mail service." This is not a cost savings in my opinion. CareMark is a very large PBM; they should be able to get us the cheapest prices out there.

Shirlee Zerkel

------- From Shirlee, Sept. 22, 2006:

Dear Mr. Russell:
I am sorry that I did not spell the prescribed medicine correctly. The correct name of the drug is Folgard 2.2. Quantity was for 90 pills. What tier is that medication on? I can not find it in the information from CareMark. I am asking why CareMark charged $46 for the 90 pills or about 51 cents per pill when we have inquired locally and retail pharms have the cost from $16 to $20 for 60 pills. Let's suppose that we use the $16 figure; that amounts to about 26 cents per pill. That is almost double what we are charged through CareMark.

Thank you for your answer,

Shirlee