Sunday may be a post-Halloween shock for state employee and retiree patients. They may or may not have received a letter from Caremark informing them that "our records show that you recently filled a prescription at a pharmacy that will no longer be participating in the HealthSelect network as of November 1, 2009."

The letter tells them they can call Caremark or go online to find a participating pharmacy, but not until Nov. 1 when their current pharmacy can no longer fill their prescriptions. Some who receive the letter may not read it right away, or even at all. The entire situation is confusing and stressful to pharmacies and our patients.

So you should be prepared to help your patients through this "haunted house," especially if you have decided not to continue serving patients through the Employees Retirement System/Caremark contract. Click here for some talking points to help your patients understand why you are unable to continue with the ERS/Caremark contract or why it will be difficult for you to continue, and let them know what they can do to help rectify this problem.

It may help to know you're not alone with your decision. Kroger, Target, and Walmart, two independent networks representing more than 500 pharmacies, and an undetermined number of non-network independents also have opted out.

At least that's the count at the time we're writing this PharmPhlash. Others also may drop out or opt back in. The exact number of participating and nonparticipating is a ghost number right now as pharmacies try to work through the unexpected news and short time-frame for making their decision.

The details are too gruesome to go into, but suffice it to say that if any pharmacy, whether in or out of a network, wants to contract with Caremark at the new reimbursement rate, they can. Good Neighbor Pharmacy Provider Network members can follow instructions in this letter from ERS  or this GNP Provider Network letter.

Some independent pharmacists who are not in a network report their patients have received the Caremark letter. If you learn that any of your patients received the letter, please let us know.

Whether you decide to continue with the amended ERS/Caremark contract or opt out, please contact your state legislators with the following information.

Here is extensive background information about this situation.

Here is a shorter version of the talking points for yourself and for your patients.

Now that you have the information you need, please follow through by contacting your state legislators about ERS attempting to cover its own shortfall by shortchanging pharmacies and beneficiaries.

Click here to find out who your state representative and senator is, and how to reach him or her. Share some of the points made in this PharmPhlash and let us know who you contacted and their response.

If you decide to no longer participate in the ERS plan, we would appreciate knowing that as well.

Stay tuned!