IS CAREMARK NOW PLAYING 'DOCTOR' -- AT THE EXPENSE OF OUR HEALTH? Read this and seethe!

From John Curry, March 1, 2007
Subject: Caremark

The letter below came to me from an STRS retiree (and fellow CORE member) who asks the question, "is there going to be a stop to Caremark running our healthcare and our doctors?" I have removed the retiree's name from this email for privacy .... even though she advised that she didn't mind if her name was distributed.

After contacting her by phone (a few minutes ago) I learned that she has been on this particular drug (Provigil) for years (with Caremark being the supplier) and advised that, although it IS on their list of covered Rx - now, Caremark will not continue to provide it to her - at the now Tier 3 (up from Tier 2 last year) co-pay price without going through additional batteries of tests.

She advised that her physician has appealed Caremark's decision BUT THIS TAKES TIME AND SHE NEEDS HER MEDICATION NOW TO FUNCTION. She was referred to contact Gary Russell at STRS even though she advised that she talked to a person (lower level) at STRS who was unable to give her any satisfaction. She advised that she would keep in contact and relate any additional problems with obtaining this badly needed medication. NO PERSON SHOULD HAVE TO LIVE THEIR LIFE LIKE THIS!

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From: (Name withheld for member privacy)
To: John Curry
Sent: Monday, February 26, 2007 8:33 PM
Subject: Caremark

Hi John,

Can you please help me or refer me to someone who can help me with my medication? I have narcolepsy, a sleep disorder, and I have taken Provigil for five years.

Today, Caremark told me that this drug is no longer covered. I was told that this was decided by my STRS plan and a committee at Caremark. The rep could not tell me who to contact about this. I was told that my doctor could appeal, and she has done so today. But, this will take weeks.

The rep told me that I was denied because I will need further testing done to ensure that I don't have some other sleep disorder or to ensure that narcolepsy does not stem from a mental disorder, or to ensure that I do not have a mental disorder.

All of this testing will cost thousands of dollars, there are hundreds of mental disorders I could be tested for(which I don't have), and I have had two diagnoses from two doctors that I have narcolepsy.

In 25 years I have had every neurological test and scan done to determine what I don't have...and now Caremark wants me to have more...

I was reading an email asking, "where can I "turn in" Caremark?" I once talked to a person at STRS about another drug that was denied, and it was on the list of approved medication with prior authorization...what a waste of my time...she gave me a smart answer...so I just dropped it. I told the STRS rep that the drug was in the 2006 booklet as approved, but she said "everything can't be put in that book".

Also no where in my 2007 booklet does it mention this problem with Provigil. Is there going to be a stop to Caremark running our health care and our doctors?

Thanks,

NAME WITHHELD FOR MEMBER PRIVACY