Saturday, March 10, 2007

Hey, see our fair state on this list??

From John Curry, March 10, 2007
Subject: Do you notice something missing?
District of Columbia
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Rhode Island
South Carolina
South Dakota
West Virginia
Did you notice anything missing? Right, the Buckeye State! Now, what kind of list is this?
The states listed above (36 of them plus the District of Columbia) have all either passed or introduced a bill in their legislature to regulate Pharmacy Benefits Managers! How 'bout good 'ol progressive (?) Ohio? Not!!!!!!!
This information was taken from a report from the Office of Program Policy and Government Accountability - Report No. 07-08 - State of Florida - here is a link to that 12 page Adobe download

John Curry to Prosecutor Lara Baker: Is an investigation still under way at STRS?

From John Curry, March 10, 2007
Subject: investments staff at STRS
Ms. Baker,
It has been quite a while since many former STRS Board members were successfully (and skillfully) prosecuted for violations of Ohio ethics laws. During that time period Mr. Freel, of the Ohio Ethics Commission, related that the investigation into the investments staff was still continuing.
With the above in mind and the fact that those Broadway musical tickets didn't just "fall into the laps" of the STRS Board members .....I ask the following question: Has the investigation and/or prosecution of certain STRS individuals in the STRS investments department been forgotten or is this issue closed? Thank you for viewing this email, doing what you have done in the past for ensuring a "new way of doing business" at STRS. I hope that you will give our retirees an answer to this issue that is still on the minds of thousands who are wondering if closure on this issue has finally been reached.
John Curry
An STRS retiree

Molly Janczyk re: 13th check and COLA

From Molly Janczyk, March 10, 2007
Subject: 13th cks and COLAS: Ohio STRS to get 66.5 mil for AOL "cooking the books"
Actually, I believe 13th cks and COLAS are from discretionary money as well when STRS had such and were at 30 yrs unfunded liability or below. While it is questionable that we HAVE to by law be at 30 yrs or below for other perks, it is recommended at the least by the state. It is like a mortgage: We are now at 47.7 yrs to pay off all liabilities vs. 30 yrs or less to pay off liabilities. Just not a good place.

"Duke" Snider: Some questions

From Molly Janczyk, March 10, 2007
Subject: RE: Fw: Questions
1. I forget the fund, but where court-won monies go has been answered. Damon can tell us.
2. HC costs cannot come from the pension monies regardless of amount until unfunded liability is at 30 yrs or less at which time STRS can direct more to the HC fund. If liability is over 30 yrs, it must go to pensions.
3. Ramser, in my opinion , will never resign. She thinks she's rt. and doesn't listen to membership, again, in my opinion.
4. Puckett: thick and sure has never seemed to care about spent money.
Lost cause on #4 and 5 . Just my opinion.
WHEN ARE THE ETHICS VIOLATIONS GOING TO CONTINUE? We haven't heard a word. I doubt any will be seriously penalized, though. It will be like Taft. Freel said STRS hasn't been found to have the severity of violations such as OF&P. But, they said all levels of staff would be involved for misdemeanors. Catch 22: Some of that staff is earning buckets of money for us and operated under an entitled Director. Doesn't excuse anything but we are outperforming pension systems in Ohio and the Nation -- just makes me nervous, is all as my first concern is membership and staff that can put us back to secure.
Just my opinion. Nothing more.
From John Curry, March 10, 2007
Subject: Fw: Questions
Duke raises some good questions! Food for thought. Thanks, Duke.
"Duke" Snider to John Curry, March 9, 2007
Subject: Questions

John, Some questions
1. What happened to all the people who were supposed to be charged by the Ethics Commission?
2. According to email, STRS is supposed to get 66.5 million dollars (AOL) -- What is going to happen to this money when STRS receives it?
3. Maybe it's my imagination, but I've read some emails stating in the past few years STRS has done quite well making money -- Then why is health insurance so high for retirees, retirees don't receive a 3% compound raise, no 13th check and on and on?
4. When is Ramser going to do STRS retirees a favor and resign?
5. Wonder how Puckett feels about who spends the most money on meals?

RH Jones: That $66.5 million should go to HC and 13th check

From RH Jones, March 11, 2007
Subject: Ohio STRS to get 66.5 mil for AOL "cooking the books"
To the CORE leadership:
At the next CORE meeting with Damon, add Dr. Fluke's and my name to the list of those who wish the $66.5 mil to go to fund HC & to issue a 13th check this year. This money was lost to us at a time in early 2000 when, if we had it, it would have been spent on HC & 13th ck. funding. Spending the money in this way will help reestablish trust that our STRS is looking out for retirees.
[Click here for related article]

From Molly Janczyk, March 11, 2007
: Unfortunately, it cannot go to HC, until unfunded liability is at 30 yrs or below as recommended by the state. I don't know about COLA or 13th cks.

OFT honors State Rep. Brian Williams

From RH Jones, March 10, 2007
Subject: OFT awards State Rep. Brian Williams!
To all:
The OFT awarded the Ohio 41st. Dist. State Rep. Brian Williams (D) a "Friend of Public Education Award" last Friday. This was in recognition of his contributions to the defense and improvement of public education. Hopefully, ORTA will give similar recognition.
Keep up the good work Brian! We need more representatives like Brian who have the children, their public school teachers and their retired teachers at heart.
RHJones, CORE and SummitCRTA Leg. CMTE Mem.

State legislator gets teachers' award

Akron Beacon Journal, March 10, 2007
AKRON - State Rep. Brian Williams received a ``Friend of Public Education Award'' Friday at the 69th annual Ohio Federation of Teachers (OFT) convention in Columbus.
Williams, D-Akron, was an educator for 37 years, including six years as Akron's superintendent. He is in his second term as a state representative.
The OFT award recognizes people for their contribution to the defense and improvement of public education.

Friday, March 09, 2007

Get well cards for our friends.....

March, 2007

Get well cards.....

.....John Lazares (wife is Trish)
.....8133 Devonshire Pl.
.....Maineville, OH 45039
Home phone: 1-513-583-7611
Cell: 1-513-967-8786
E-mail: (uses his cell for this)
.....Paul Boyer
. ...3500 W. Elm Street. Apt 203
Lima, OH 45807-2289

Molly Janczyk to Damon & Board: The MEMBERSHIP should be YOUR PRIORITY

From Molly Janczyk, March 9, 2007
Subject: Dear Damon and STRS Board Members: STRS Board Meetings
Dear Damon and STRS Board Members:
You well know we are most interested in HC issues and pension preservation. There is no secret here on these issues. WHY would you schedule HC and pension on Fri. and Public Speak on Thurs.? This seems a deliberate attempt to split attendance or discourage it. WE ARE the PENSION system living the reality of STRS HC! PLEASE, AGAIN! Take YOUR members into consideration when planning meetings. THURS IS MEMBERSHIPS' BEST DAY AND THE DAY TO DISCUSS THOSE ISSUES AND HAVE PUBLIC SPEAK ON THE SAME DAY FOR OUR CONVENIENCE! YOU serve US! It is conscionable for Conni to plan HER week around HER! We SHOULD BE YOUR PRIORITY PER 3307.15! Again,it seems anything BUT. Please respond to these issues.
**DAVE P: I would like this on the agenda for the next Damon/CORE Meeting. How unthinking towards membership.
Molly Janczyk

There's a new sheriff in the Governor's Mansion!

From John Curry, March 9, 2007
Subject: There's a new sheriff in the Governor's Mansion!

Ted Strickland wasn't first. He took a page out of Dennis Leone's playbook re. STRS Board spending for meals! Finally, .... a sense of common sense for state agencies. Thank you, Dennis!

New games at STRS?

From Mary Ellen Angeletti, March 9, 2007
Subject: STRS Board Meetings
I just received my STRS schedule for the March meetings in the mail. The only thing scheduled for Thursday morning is a disability review in exec. session. At 1 is the usual Exec. Director's report followed by Public Speaks, and a report from Steve Mitchell on the Investing Dept. AFTER the recess of the meeting, an Ad Hoc committee will review webcasting (isn't that interesting, John?) so we are not allowed to attend this. On Friday, the Retirement Bd. meets at 9 with reports on health care and pension benefits.
So retirees are now required to attend both Thursday and Friday to stay informed. When are we supposed to schedule our CORE meeting???? IS THIS AN ATTEMPT TO DISCOURAGE RETIREE PARTICIPATION & CORE OR NOT?????
Mary Ellen

A RESOLUTION to Why was my approved prescription denied-Part IV

From (Name withheld to protect privacy) to John Curry; March 9, 2007
Subject: Just a follow-up
I do need to clear up a few things for all who may be reading. Before I retired, I tried many drug combinations to help me with the Narcolepsy symptoms. And, the drugs do treat the symptoms, but there is no drug that will help the problem. It is forever, and with the drugs I can live a "normal" life. It could be compared to being a diabetic; insulin will help the symptom but not cure the problem.
I know all about the side effects of these narcotics, I have never abused them or used them inappropriately. I just hate it when any reference is made about the improper use of medications. Remember I have used the same two drugs for 5 years. I also would not spend a penny that was not necessary for these medicines. My doctor usually has given me samples of medicines to try before I fill a prescription.
Before retiring, I had two different complete sleep studies done. Each test takes two days in a sleep facility, and at times they were grueling. My first test was done in Dublin and the second one in Huntington, WV. I also spent 5 days with the neurological department at OSU. Sleep study tests rule out what person does not have, and then the tests indicate what sleep problems a person has. It is too complicated to write any more about the tests. Not only have I been diagnosed with Narcolepsy but obstructive sleep apnea, restless legs, and cataplexy. My retirement system did not pay for any of these. I'm not complaining about the disease; it could be something worse. I just wanted my medication. I haven't decided if I'm offended about some of the comments made to explain why my drug was denied.
But, the good news ...someone has fixed by problem. Maybe it was Brenda Foster at STRS. Caremark called me this A.M. to tell me that my medication has been approved. This rep was extremely nice and was eager to help. She told me that this had really "gone up." I thought she meant the price of Provigil, but she really meant at Caremark. She had talked to my doctor earlier, and the drug is to be sent as soon as Caremark receives the prescription... which I sent on Tuesday. It will come express mail at their expense. I asked if my doctor had caused any of this mess, and she said no.
I also received a prescription for a 10 day supply of my other medication. When I went to pick it up it was $50. I had them to check to see if it was mine, YES, was it the generic I asked for, NO, the pharmacy was out and none to be had until next week. I asked for my prescription back...that was too much since I did pay $30 for 270 pills from Caremark. The Caremark rep offered to override the Brand cost for me at the local pharmacy, but I didn't want that...I took it to 2 other pharmacies until I could get the generic...which costs $10. Remember I told you I live in southeastern Ohio, and I am a proud Appalachian.
I am appreciative of your help, Brenda Foster's at STRS, and Stephanie Watson's at Caremark.
Another short piece of info...I never heard anything from Medical Mutual about the need for further testing that my doctor did not prescribe for me.
(Name withheld to protect privacy)

John Curry and Gary Russell on denial of approved prescription

John Curry to Gary Russell, March 8, 2007
Subject: Re: Gary: "Why was my approved prescription denied"?

I thank you for the background and divulging that it is Caremark that makes
the determination re. prior authorization and/or denial decision - the
retiree (in this case) was told by Caremark that it was STRS who made the
denial of the prescription. A point not addressed is that the notification
of denial to retiree (in this retiree's instance) came in the mail almost
two months after the denial was determined. This delay is unconscionable.

What can you relate as to the timeliness of the notification of denial by
mail (or by other means)... what "timetable" is Caremark held to for this
notification? Thank you for your response.
From Gary Russell, March 8, 2007
Subject: RE: Gary: "Why was my approved prescription denied"?
Caremark administers the prior authorization program and makes the determination through consistent protocols that are based on clinical decisions. This program is a benefit to both the retirees who are prescribed the medications requiring prior authorization by assuring better use of medication and a benefit to all enrollees by assuring that your health care dollars are spent wisely.
Perhaps a couple of examples will help you understand the benefit of prior authorization. As I noted in my earlier email, there are drugs on the approved list for narcolepsy that require prior authorization. It is not uncommon for a doctor to prescribe a drug to help the person stay awake during the day which treats the symptom but not the problem. The symptom of not being able to stay awake during the day may really be the result of a sleep disorder that hasn't been identified through appropriate tests. The prior authorization process looks to see if those tests have been administered to rule out a root cause of not being able to stay awake during the day. The patient is better served by this. Another example is the prescribing of Lamisil for toenail fungus. Lamisil is only effective if the discoloration of the toenail is a result of fungus; however, doctors will prescribe this medication to see if it works without first testing to see if there is fungus present. If fungus is not present, Lamisil will have no impact and the patient would have taken an unnecessary medication and your health care plan would have paid for an unnecessary medication.
I want to assure you that no one is denying coverage just for the sake of saving money for your health care plan. No associate at STRS Ohio is better off as a result of a drug being denied to a retiree. The prior authorization program is there to help ensure that drugs are being used judiciously and as a result that we aren't spending your health care dollars unnecessarily.
Gary Russell

Update on Paul Boyer

Molly Janczyk to Paul Boyer, March 8, 2007
Subject: RE: To all my CORE friends
Dear Paul,
I am so sorry to hear of your recent health problems. Please know you are in our thoughts and prayers for your improved health. I am very concerned and hope you are receiving the best of care. I hope this finds Alice doing alright as well. This has been a tough year, dear friend. You are always an example and model of perseverance and doing the right thing. Sending the warmest wishes for your well being. Know we always hold you close and you are a most valued comrade. We care.
Love, Molly
From Paul Boyer, March 8, 2007
Subject: To all my CORE friends
Molly, please tell all my CORE friends that I have been very ill recently. I have had two short stays in the hospital. My lungs had been covered so badly with fluids that I could hardly breathe. They had to give me shots and a drip bag of lasik. I am still weak but improving, I have had to type this short note several times to get it right. Please continue to pray for me.

Study: Spend more on schools

To all:
This important study was very comprehensive but did not, to my knowledge, mention the drastic negative drain of for-profit schools, combined with home schooling and other failed experiments, has had on funding our Ohio Public School Districts and the STRS. Further, Ohio citizens should note that educators express great apprehension about the recent legislature requested increases for additional private schools throughout our state. These legislators who should be identified exposed to the media.
At for-profit schools, children have become units from which financial gain is derived. There, they are seen not as children but commodities! This industry continually spends large amounts of their profit gains on lobbying certain legislators to increase student population. Those so called "schools" are nothing more than factories that cut overhead by staffing them with poorly qualified, and consequently, poorly paid teachers. Also, while good for profits, overcrowding and reduction of services to the child has led to mediocre student achievement.
Grown-up citizens have a moral obligation to vote politicians out-of-office who have failed to support public education funding PreK-16. Personal freedom and prosperity for all depends on it.
RHJones, a proud CORE member

16-31 percent increase urged, up to $4.8 billion more
Akron Beacon Journal, March 6, 2007
Beacon Journal Columbus Bureau
For years, state officials have been talking about the need to give each child in Ohio a world-class education, and finally a price tag has been attached to the idea: $2.4 billion to $4.8 billion in new money.

The group that developed the plan is not the coalition that has successfully sued the state four times in the past decade, but a team of researchers at the University of Washington, funded in part by the Bill & Melinda Gates Foundation, which has been sponsoring education research around the country.

The study suggests that Ohio should spend as much as 31 percent more on public education for such changes as longer school years, lower pupil-teacher ratios and significant improvements in early education.

A working draft of the study, called Education Policy and Finance Project for Ohio: Investments to Improve Student Performance, done by researchers at the Human Services Policy Center at the University of Washington, was obtained by the Beacon Journal through a public records request.

Last week, the Ohio Department of Education used the paper to brief Gov. Ted Strickland's administration, legislative leaders and a policy committee within the agency.

Researchers generated recommendations for a variety of school settings by talking to education officials who were part of state- and school district-level teams.

Poor urban districts preferred policies to lengthen the school year and meet the needs of the poor; rural districts preferred increasing teacher pay, reducing class size and extending the school year. Wealthy suburban districts were mostly satisfied with funding.

The costs of eight scenarios were calculated. Total spending would increase 16 percent to 31 percent, depending on the policy chosen, and the average spending for each Ohio child would increase from the current $9,300 to a range of $10,722 to $12,128 per pupil.

In addition to longer school years, the study addresses early learning, more money and training for teachers, especially math and science instructors, and an effort to drive more dollars toward reducing teacher-student ratios in poor and rural districts.

Although the price tag is high, the report notes ``the state team moderated the investments to bring the costs toward a more feasible range.''

10th anniversary

On March 24, the state will mark the 10th anniversary of the initial Ohio Supreme Court ruling that ordered lawmakers and the governor to fix the unconstitutional school funding formula for 1.8 million children.

Strickland pledged in campaigning to bring groups together to address school funding. The coalition of school districts that won the landmark battle is gathering signatures to ask voters this November to amend the Ohio Constitution after the Supreme Court refused to enforce its four previous orders.

Keith Dailey, Strickland's spokesman, said the governor's education policy advisers are reviewing the study and holding comment until the final report is issued in several months.

``We're taking this very seriously, just as we have taken the other education studies recently released seriously,'' Dailey said.

Maggie Ostrowski, an Ohio Senate spokeswoman, said Senate President Bill Harris, R-Ashland, and Education Committee Chairwoman Joy Padgett, R-Coshocton, were unable to attend the briefing last week and were waiting to review the study before commenting.

Karen Tabor, spokeswoman for House Speaker Jon Husted, R-Kettering, said her caucus members are also still looking at the study.

Paolo DeMaria, an education department analyst, said the study is more a blueprint for finding ways to link academic outcomes to funding than it is determination of the cost of adequate school funding, but he acknowledged that often the discussion ends when costs are pinpointed.

He said the University of Washington group has been looking at Ohio for about two years, and the final report will be combined with information from other studies to help guide state education policy and funding.

``You're beginning to see states wrestle with the notion of how do you go down these parallel paths,'' DeMaria said.

William Phillis, executive director for the Coalition for Equity & Adequacy in School Funding, said the study's methodology examined the needs of children and determined more money was necessary.

Phillis said that for years, state lawmakers have relied on residual budgeting for schools, meaning they set aside an amount of money based on available funds rather than determining what is needed.

``The discussion now should be which of these modes, needs or residual budgeting, are we going to follow,'' Phillis said.

Jim Betts, a spokesman for the Campaign for Ohio's Future, which is gathering signatures for the proposed constitutional amendment, said he has not seen the report.

``We welcome the kind of work this University of Washington study has done and believe this is the type of discussion that is needed in the state,'' he said.

Year-round instruction?

The eight scenarios range from keeping the current 168 days of classroom instruction, but extending the school year to 188 total days, to year-round schooling divided into three semesters, with 185 classroom days and 205 total days.

The researchers tried to estimate the cost of each scenario, noting the most expensive approach would be year-round schooling, with the state ensuring a specified amount of extra funding for each child in poverty.

Critics of teachers and their pay will find unwelcome news in the study, which found teachers are underpaid in Ohio and said that the starting salary should be increased to $30,000, with 4 percent pay raises annually.

The pay for teachers in high-demand areas like math and science should be 25 percent higher on average, the study said.

At the same time, there should be more teachers.

The study calls for two or three fewer students per classroom in poor districts.

This means that in poor districts, the teacher-student ratios should be 15-1 in elementary schools, 20-1 in middle schools and 22-1 in high schools.

Recommendations include five to 10 days for teacher development, coaching and mentoring new teachers, but the report also notes that classroom instruction days should not be sacrificed for teacher development, student assessment, parental meetings or administrative tasks.

Strickland has emphasized the need to focus on preschool children and the report appears to echo his sentiments by recommending creation of a State Board of Early Learning, funding all-day kindergarten and creating an Early Learning Initiative for children living in families making up to 250 percent of the federal poverty level.

The early learning initiative would fund 6,000 preschoolers and 2,000 infants and toddlers.

Researchers acknowledge throughout that they lacked the information and expertise to make recommendations for special-education students, so in most cases, the report indicates current practices and spending policies were followed.

A number of commonly held beliefs were challenged.

For example, the study contends there is no evidence that student aides improve results, especially as children grow older, so the report recommends placing assistants only in kindergarten classes.

Also, the report notes that private tutors should not be used, but instead staff, volunteers and peers should be enlisted to help students with lighter caseloads in poor districts.

The federal No Child Left Behind Act moved tutoring toward private for-profit firms that provide services to students outside the school district.

Dennis J. Willard can be reached at 614-224-1613 or

RH Jones: Funding for Ohio's public schools; how to obtain OEA petitions to circulate

From RH Jones, March 9, 2007
Subject: Where you can get OEA Petitions for increase in state funding
To all:
Active & retired educators, you can e-mail OEA at: to send for your petitions to circulate.
Active teachers have been asked to donate $25 to help fund this movement. It is to get proper funding for our public school children on the Ohio ballot. As a retired teacher, I feel a contribution of $12.50 is reasonable. Contribute what you can. Retired administrators may wish to donate more. Personally, I will mail them a $12.50 check as soon as I can find where to send it. I'll let you know.
We need to support OEA 100% in this fight for our public school children and their teachers. I do not think that charter schools, home schools, or any other type of private school, that takes our hard earned tax dollars away from the public school districts of Ohio, should be tax funded. Our public schools nationwide and in Ohio have kept us free and prosperous for 200-years. Our public schools, their children and teachers, need our full and complete support. And, personally, I will oppose any politician who shows an affinity to grandstand against our beloved traditional public school system. I hope that you to!
Robert Hudson Jones, Life Member Builder of OEA and a very proud CORE member, as well.
From OEA Member Matters (March 2007):

You can help make public education a fundamental right!
Volunteer to circulate petitions for the school funding amendment

The proposed constitutional amendment on school funding would result in better education for students and a fair system of funding for all Ohio public schools. It will establish a fundamental right for all Ohio students to obtain a high-quality public education. But to do all that, the proposal first has to get on the ballot, and that can only happen if we obtain 402,000 valid signatures on petitions for the amendment.

You can help. If you’re asked to sign a petition, please consider doing so. If you want to volunteer to circulate petitions, all you have to do is contact your local association president or your assigned OEA Labor Relations Consultant. If you are unsure how to contact the appropriate OEA office, you can contact Julie Parsley or Bonnie Joseph at OEA. Call 614-228-4526 or 1-800-282-1500 toll-free. If you want to volunteer by e-mail, send your name, phone number and local association affiliation to, and an OEA representative will contact you to help.

Thursday, March 08, 2007

John Curry comments on the "Maine Law" re: PBM transparency

From John Curry, March 8, 2007
Subject: The "Maine Law" re: PBM transparency
Gee, I wish the "forward thinking" Ohio legislators would have the political courage to introduce a bill which would parallel the "Maine Law" as it relates to transparency of pharmacy benefits managers. The temporary injunction (sought by Big Pharma) against this Maine Law has now been suspended. Below is a summary of the Maine Law. John

As a general rule the amount of fees and rebates that a manufacturer pays to a PBM has been kept "secret." These fees and rebates improve the chances of a particular drug to be sold by a PBM. Maine was the first state to introduce legislation to force the PBMs to disclose these payments. Several other states have now followed Maine in enacting similar legislation. The law became effective in Maine in September 2003. In granting the temporary injunction against compliance with the law, the judge said that PCMA "has demonstrated substantial likelihood of success" in its argument that the Maine law is preempted by the federal benefits law, the Employee Retirement Income Security Act of 1974.

The Maine law also requires the PBMs to pass along to their clients the volume-based discounts they get from a drug maker. The law also requires the PBM to get the physician's approval if a prescribed medication is to be switched. It also requires the PBM to tell the individual and the health-insurance provider the cost of the prescribed drug and the drug that the PBM wants the patient to be switched to. Violations would be punishable by a fine for as much as a $10,000 per violation."

John Curry and Molly Janczyk: Questions for Gary Russell

John Curry to Gary Russell, March 7, 2007
Subject: Re: Gary: "Why was my approved prescription denied"?
Who deems "inappropriate" in the phrase "the inappropriate prescribing of drugs?" If it is the doctor who made an "inappropriate" decision in his/her professional judgement, then that should be dealt with in a complaint against the physician. If it was not the physician who made an "inappropriate" medical decision concerning which Rx to prescribe... then it was either Caremark or STRS who is making a judgement that the doctor's choice of Rx was inappropriate... this is tantamount to "playing doctor." In this particular retiree's case... the denied Rx was and still is on the STRS/Caremark's list of approved medications.
I realize that millions of dollars were saved by "denying coverage" for Rx that did not meet prior authorization standards but at what cost to the retiree (and other retirees) who badly needed these pharmaceuticals? How many of them went without because they couldn't afford it? The lady who was denied her Rx (in this particular case) was notified of "denial" by mail almost two months after the fact. This lack of timeliness is not a service to retirees.
John Curry
Gary Russell to Molly Janczyk, March 7, 2007
Subject: RE: Gary: "Why was my approved prescription denied"?
Dear Molly,
There are a number of drugs that require prior authorization. These are drugs that may cause potentially serious side effects and/or have a high potential for inappropriate use. For example, there are 16 drugs in the ADHD/narcolepsy category that require prior authorization. It is not uncommon for one of these drugs to be prescribed for narcolepsy when other sleep disorders have not been ruled out. Prior authorization is a clinical decision that ensures the appropriate use of a drug.
The inappropriate prescribing of drugs also has a cost impact to your health care plan. Your plan avoided $12 million in drug costs last year by denying coverage for drugs that didn't meet the prior authorization standards. This is a benefit to everyone in the plan since resources are limited.
If prior authorization is denied, then there is no coverage for the prescription. The enrollee may still get the drug; however, he or she will be responsible for the full cost. Prior authorization does not determine which tier a drug is on for the purposes of copayment, prior authorization determines if the drug will be covered.
I hope this helps explain the role prior authorization plays in the administration of your health care plan.
Gary Russell
From Molly Janczyk, March 3, 2007
Subject: Gary: "Why was my approved prescription denied"?
Please advise on the following:
Below should be accurate. I don't think STRS does deny any drugs but they decide which are on tier 1, 2 , 3 due to costs, etc. They decide which are to have prior authorization. You can get drugs off formulary at $125. STRS has decided to stop Prescriber Advisor, I thought, where letters are sent to your Dr. re: drugs.
I am not certain if that means Caremark has taken over that role. All pharmacists are supposed to advise of contraindications among meds and advise patients and Dr.'s as Dr's don't always know as much on that issue as pharmacists. But the final decision is up to you and your Dr.
Bottom line: Does Caremark ever deny a drug and if so why?

Wednesday, March 07, 2007

State to get $144 million from AOL Time Warner in fraud settlement (STRS to get $66.5 million)

State to get $144 million from AOL Time Warner in fraud settlement
By Tracy Turner
The Columbus Dispatch, March 7, 2007
Five state pension funds and the Ohio Bureau of Workers' Compensation will receive $144 million to settle a securities fraud lawsuit filed against AOL Time Warner.
The suit said AOL inflated its stock price before merging with Time Warner, causing the funds to lose millions, the Ohio attorney general announced today.
The lawsuit, filed in 2003, claimed that the six funds lost nearly $400 million when the price of AOL Time Warner stock fell from $48 per share to less than $10 a share. The decline followed the discovery that AOL had misrepresented sales, revenue and subscriber figures in advance of the merger, Attorney General Marc Dann said.
The settlement is “a loud and clear message to corporate America and to Wall Street, that we as, investors, citizens and pension holders, will not tolerate fraud, stock manipulation or deceit,” Dann said during a news conference in Cleveland to announce the settlement. “If you abuse the public trust and steal from taxpayers, you will pay the price.”
Ohio opted out of a class-action lawsuit against the company and instead chose to negotiate on its own. As a result, the six funds will receive $144 million, compared with $9 million that would have been received as part of the class-action suit, Dann said.
The agreement calls for the bureau, the State Teachers Retirement System, Public Employees Retirement System, the Police and Fire Retirement System, the Highway Patrol Retirement System and the School Employees Retirement System, to receive the funds by March 22. All of the funds owned Time Warner stock prior to the settlement.
The settlement is the largest securities fraud case involving pension funds in Ohio's history, Dann said.
“AOL's blatant disregard for the rule of law and willful abandonment of ethical business practices is deplorable,” he said. “Hopefully, the heavy price they now have to pay will deter others from using the same deceptive tactics in the future.”
Bob Smith, a board member with the Public Employees Retirement Fund, called the settlement a “good outcome.”
“The (funds) losses were significant … we are very pleased with the settlement,” he said.
The settlement will be distributed as follows:
  • State Teachers Retirement System, $66.5 million
  • Public Employees Retirement System, $62.3 million
  • Bureau of Workers' Compensation, $8 million
  • Police and Fire Retirement System, $4.1 million
  • School Employees Retirement System, $2.5 million
  • Highway Patrol Retirement System, $290,778


John Curry to Gary Russell, March 7, 2007
I think you might find this interesting. Judging from STRS's past experiences with Medco and the resultant law suit settlement, I believe the type of reform mentioned in the article below would be a worthwhile "mention" to Ohio legislators. You may hold out hope for honesty in some PBM's, but I am not that positive..... neither are a significant part of the American public.
John Curry
From: Sharon Treat at National Legislative Association
Sent: Tuesday, March 06, 2007 3:39 PM
By the attached
opinion (PCMAMemOpinion.pdf), issued today, Judge Urbina of the US District Court for the DC District granted the motion of the District of Columbia to vacate the preliminary injunction and for summary judgment. The Court found that plaintiff is precluded from relitigating the issues raised in the First Circuit litigation. Thus, the DC PBM law, which is very similar to the Maine law, will now go into effect.
Sharon Anglin Treat
Executive Director
National Legislative Association on Prescription Drug Prices
P.O. Box 492
Hallowell, Maine 04347
Tel. 207-622-5597
Fax. 207-622-3302
The National Legislative Association on Prescription Drug Prices is a nonpartisan organization of state legislators working jointly across state lines to reduce prescription drug prices and expand access.
For information about the DC case contact:
Andrew J. Saindon
Assistant Attorney General
Office of the Attorney General for the District of Columbia
Equity Section I
Civil Litigation Division
441 4th Street, N.W.
6th Floor South
Washington, D.C. 20001
(202) 724-6643
(202) 727-0431 (f)

From Jim N. Reed -- a cost saving tip re: free phone directory information

Jim N. Reed to John Curry, March 07, 2007
Subject: Re: Get ready to get bilked again!
John, I'm certain most readers are aware of the toll-free, but not commercial-free, services that will provide phone number information without a charge. In case some may not have access yet, this number should give them free information:
1-800-303-3411 [or 1-800-FREE411]
Hope this helps someone.
Alexander Graham Bell received the patent for the telephone today-in-history in 1876. He's probably getting a "call-waiting" on this one!
What will corporate American charge us for next? Oops, better not go there!
By the way, that was a legitimate question I asked you about whether anyone knew of any PBM or pharmaceutical company that had an approved program that would permit a physician's "over-dosage" prescription allowing the patient to pill-split.
Good for Marc Dann! We need more bulls like him in the corporate America's china shops! Sic 'em, Attorney General!
Jim N. Reed
[Click here to learn more about 1-800-303-3411, a.k.a. 1-800-FREE411. KBB]

Tuesday, March 06, 2007

Update on John Lazares

From Molly Janczyk, March 5, 2007
Subject: John Lazares

Tricia said the Dr. told her the surgery went well; John's bone has hardened and he was able to get a secure, strong implant. His patella ligament is strained from all this and so he will have to take it easy for a while and need some special rehab due to all the scar tissue.

But overall, it is good news unless and until we hear differently and we don't want to hear anything but good news for John.

He is expected to be in the hospital for about 3 days and then be discharged.

Mercy Hospital:
3000 Mack Rd.
Orthopedic Unit for now; Rm. later???
Fairfield OH 45014

Home Address:
8133 Devonshire Pl
Maineville OH 45039

More on Caremark denying medication to a retiree

From John Curry, March 6, 2007
Subject: Fwd: Why was my approved prescription denied? (Part III) & an almost 2 month delay for notification by mail of denial

The letter below is being shared with the permission of the author.
This STRS/Caremark "Rx covered" retiree is insuring her spouse through a non-STRS healthcare provider. Food for thought: Why should it take almost two months to be notified of an Rx denial? Is Caremark/STRS playing doctor? Is "Urgent" the magic word that you must remind your physician to use so that you will be assured that you will get your medications that your very own physician deems necessary?
I find it interesting that STRS still is contracted with Medco for their (our) employees' prescription needs considering the fact that STRS recently successfully sued Medco in 2005 (another PBM) and is to receive millions of dollars in that court-ordered award (see that article below the STRS retiree's letter that follows). Possibly we are still contractually obligated to Medco... then again, maybe we aren't. I wonder if there are other STRS retirees who have waited almost two months before receiving their "denial" letters while they were looking forward to receiving their dearly needed medications? John
Hi John,
I did talk to Brenda Foster on Monday. She is very knowledgeable, and I enjoyed talking to her.
She told me to have my doctor to file an appeal and indicate that I have no additional sleep disorders or mental disorders. My doctor is to write URGENT on the form, and I should be approved in 72 hours. She said what happened was that my doctor checked the box NO about no additional disorders, but she didn't add write this on the lines next to the box. Brenda did say that in previous years, my doctor had checked the box NO and wrote additional notes about "no need for additional testing".
Again, she told me that the prior authorization starts with Caremark bringing the medication list to STRS. The STRS staff discusses with Caremark why there is a need to add drugs to this list.
So, Caremark told me that I was denied because I needed additional tests, and STRS said that my doctor can take care of this through an appeal. I did receive my letter of denial on Monday for this prescription that I sent 1/08/07. It took 2 months for them to notify me. This letter states I am denied because "other sleep disorders or mental disorders have not been ruled out". DSS RPh 02/26/07. The participant (me) can still purchase the drug, however, she will be financially responsible for the full cost.
I know that one of the other drugs that I was prescribed would cause me to have additional tests because I don't have Alzheimer's, and before I could have the drug, I would have to have this disease ruled out. I'm not sure that after all of this, my doctor could prescribe this for me.
I did email Medical Mutual about the tests, but I haven't received a reply.
I did ask what STRS pays for my HC; it is $488 and I pay $ $651. As I told you my husband's premium is $355, and this is not a group rate. He does have a higher deductible, all doctors and hospitals accepted, most drugs are $90 or less, and I haven't encountered any "prior authorizations".
I also asked what insurance coverage STRS employees had, and it is Medco. I wish I had asked if STRS ever says NO to Caremark's "prior authorization". I'll let you know about the results.
(Name withheld for privacy reasons)
Jury rules in Medco contract dispute
Memphis Business Journal - December 19, 2005
A Cincinnati court awarded $7.8 million to the board of the Ohio State Teachers Retirement System in its dispute with Medco Health Solutions Inc.

Medco said it will appeal the award.

The allegations made in the case were related to agreements the retirement system first signed in 1993, when Medco began providing pharmacy benefit services to the system's 430,000 retiriees and beneficiaries.

The Hamilton County, Ohio, jury handed down a decision against Medco related to non-contractual duties stemming from the business relationship bewteen Medco and STRS, according to a press release issued by Medco Monday.

STRS had accused Medco of pocketing $55 million in drug-maker rebates as well as charging $49 million in unwarranted prescription-dispensing fees from 1993 through 2001.

The Medco release said plaintiffs were seeking more than $300 million in damages, but the Hamilton County, Ohio jury rejected allegations that Medco breached its contract relating to mail-order dispensing fees. The jury was unable to reach a decision on whether Medco breached its contract related to a rebate-sharing agreement. In November, the judge in the case dismissed portions of the lawsuit due to lack of evidence.

Medco general counsel David Machlowitz said the evidence supported complete vindication for Medco.

"Although the award was a fraction of the claim made by the plaintiffs, we believe there are multiple grounds for Medco to successfully reverse this decision on appeal," Machlowitz said. "Medco's conduct was appropriate, legal, and professional, and in accord with our contract, which served the best interests of the state retirement system."

In a separate action, the jury cleared co-defendant Merck & Co. Inc. (NYSE:MRK), Medco's former parent company, of tortious interference.

Based in Franklin Lakes, N.J., Medco (NYSE: MHS) manages prescription drug benefit programs and operates a mail order and Internet pharmacy. In August it acquired Memphis-based Accredo Health Inc. for $2.2 billion to form the nation's largest specialty pharmacy.

Monday, March 05, 2007

A call for CORE members from Pres. Dave Parshall

From Dave Parshall, March 5, 2007
Subject: March 7 & 8

Dear Molly and John,

Please send out this reminder that on March 7th and 8th there is a special STRS board meeting. This meeting begins at 9:00 am and is a training class for board members and STRS members who attend about STRS financial matters. Terms will be explained etc. The presentation is from Russell consultants. This is not the regular STRS Board meeting. CORE members who can are encouraged to attend.


Dave Parshall

Sunday, March 04, 2007

Mr. T (for President) and Teaching as a Sport

From Duane Tron, March 3, 2007
Subject: Philosophy of Education?
Dear All,
I will gladly accept this challenge as well! I think we're onto something here! I think Congressman Jim Jordan ( a former student of mine ) should introduce legislation in Congress on this matter and I will support him 100%. You see the Graham wrestling team ( Jim and his brother, Jeff both won four state championships at Graham ) recruits quality wrestlers from all over the country and they have won nine state championships, their most recent this weekend. If I can pick my students I assure you that I'll look like the greatest educator to ever grace the doors of a public school classroom. The schools who don't recruit just don't seem to do as well. The kids want to come and wrestle at Graham ( Jeff Jordan is the coach ) because the program has become legendary with the kind of talent they can attract.
If a kid can't wrestle they don't accept them. If a kid can't read or write then we don't have to accept them. Right? If they don't have the academic ability to excel in the classroom we don't have to accept them and we can send them to a poor program where everyone fails! I think the good Congressman, and his colleagues, can see their way clear to agree to this formula for educating children in the classroom as well. Contrary to the conservative philosophy, "that everyone can pull him/herself up by their boot straps," those of us in the classroom know that not every child is created equally from an intellectual perspective. Unfortunately genetics does play a role in each person's ability to learn, excel, become great athletes, run, jump, remember, play music, etc. I never appreciated it when my father used to say "the acorn doesn't fall far from the tree." Now I understand! Some people can overcome handicaps, and liabilities, and many cannot. It just depends on who they have as parents, the quality of the community where they live, whether they have had the opportunity to learn to worship and trust in a higher power, and whether they have quality, and caring, people to teach them in their schools and at home.
We help children in our after-school program. Most do improve and WILL become successful. Why? Because they are in small groups of four and they have very caring teachers who work very hard with each of them. We don't have any "throw away" kids. Most will never become doctors, astronauts, or scientists but they may become successful, and responsible citizens, and "good" parents. We work very hard to bring them up to this point in their lives. They may never win a state championship in wrestling. On the other hand a few might! They may never play in the major leagues, or with a symphony, but we try and give them the opportunity just in case they have the hidden talents that have been obscured by dysfunctional homes and communities. Thomas Jefferson said that "All men are created equal!" Let me clarify what he meant! He meant that we are all created equal in the eyes of our Creator, God! God loves each of us equally regardless of our talents and abilities. Some children learn faster than others. Obviously some adults are slow learners as well! Just look at a lot of our elected officials in Columbus and Washington, DC. Want to talk about some "slow" learners?!
Read the following!
Subject: Philosophy of Education?
Teaching as a "Sport"
A state Senator (SC) says public school teachers should be paid on a scale equal to that of the Gamecocks or Tiger football coaches. The Sun News editor's agree only if teachers are required to do their jobs under the same conditions as the coaches and only if teachers expect to be fired if their students don't perform beyond a certain expectation.
I am a public school teacher in Horry County, and I accept the challenge. Pay me their salary. If my students don't perform as well as either the Gamecocks or Tigers this year, then fire me. Of course, I also reserve the right to have students try out for my class. If they don't measure up, then I have the right to refuse to teach them. I will only accept highly motivated, talented students. If any student fails to perform as I hoped he would, I have the right to cut him from the class.
I will also need a budget that will provide everything the students need to learn. I want full media coverage. I also want the school packed with cheering fans to make the students feel that what they are doing is worthwhile. I will have a full staff of assistant teachers, trainers and equipment managers to help me.
I can't tell you how much I am looking forward to my next paycheck! I had better close this letter now so that I can prepare for my weekly TV show.
Gerry Ferguson North Myrtle Beach, SC
Christina Plantz M.S. School Guidance Counselor (Grades 3-5) Oakdale Elementary
Duane Tron, Principal Springfield, Ohio
Please send this on to everyone you know, whether they are educators or not, and sign it below the last person. Thanks!
Larry KehresMount Union Collge
Division III
web page counter
Vermont Teddy Bear Company