Friday, March 02, 2007

STRS in cahoots with Caremark? Please -- tell me it isn't so!

From John Curry, March 2, 2007
Subject: Update: "Why was my approved prescription denied"?
Below is a letter (#2) from an STRS retiree who was denied her Rx - the same Rx she had been on with STRS/Caremark for years. The Rx was - AND IS - still on the STRS/Caremark list for 2007 (as it was for 2006) as a "prior authorization" Rx. Isn't it a shame that a retiree has to jump through all these hoops and initiate the "going up the chain of command" just to get satisfaction? I wonder how many other STRS retirees just "gave up" and went without their medication or painfully paid the retail price to avoid the hassle to obtain the vital Rx? This lady has courage. John
From (name withheld to protect privacy) to John Curry, March 2, 2007
Subject: Update: "Why was my approved prescription denied"?

Hi John,
Thank you for helping me get in touch with the correct person at STRS. I did phone Gary Russell and left a message. Today, I did talk to Brenda Foster from STRS; she said Gary Russell asked her to contact me. I explained my problem with my "in the booklet",approved,Tier 3, prior authorization drug, Provigil, that was denied. She said she would call me Monday after she investigates the issue.
I also told her about 2 other drugs that were denied (same status as above) but I had to do further tests for one to rule out dementia and Alzheimer's, and for the other drug I had to take a behavior modification class. As you know, I dropped the ball on that one.
She also told me that STRS does not deny the drugs. Caremark brings a list of approved drugs to STRS for (no doubt costly) consideration. She didn't say who at STRS makes the decision for denial, but this issue of denying drugs starts with Caremark. I will ask who the final decision rests with...STRS or Caremark.
I'll ask further questions on Monday...I also told her about the rep that told me"we can't put everything in the book." This statement lead me to believe that STRS and Caremark were in "cahoots." Brenda Foster assured me that STRS just has a contract with Caremark.
It was good talking with you today.
(Name withheld to protect privacy)
Larry KehresMount Union Collge
Division III
web page counter
Vermont Teddy Bear Company