This post originally appeared on my blog Nov 16,2014 and last updated Feb 4,2016. https://www.pharmaciststeve.com/genocide-in-america/ This is before the CDC 2016 opioid dosing guidelines were published and about 2-3 yrs after the opioid Rxs dispensed had peaked.  Some states have passed law in recent years, that is suppose to protect practitioners and pts when prescribing opioids to pts. But few seem to admit that they have done little/nothing to help all involved. Is all the deaths from under/untreated pain or is all the suicides just “swept under the rug” and all the relatives leave the funeral home, saying ” .. at least he/she is “at peace…”

This page is going to contain posts made on other places on the web by those in chronic pain and how the war on drugs has turned into a war on pts. The number of people who are abusing some substance is not going down, but the number of chronic pain pts not being able to get their chronic pain adequately treated is rapidly increasing… as is the use/abuse of Heroin.

History shows us other countries that have had a OVERT genocide… It would appear that our society has chosen to have a COVERT genocide. The rules/guidelines in place is like playing cards with a stacked deck  Just label it as a accident ?

And the whole process’ genesis was based on racism and bigotry War on Drugs GENESIS… BIGOTRY ?

As more and more chronic painers lose or have their therapy cut or they are more and more home bound and more and more INVISIBLE to our society.. They are emotionally, physically, mentally exhausted… many are losing or have lost the will and ability to “FIGHT” and having to deal with increased depression.

I am not encouraging or endorsing suicide.. I am trying to make those with chronic pain MORE VISIBLE to those in our society that are CLUELESS !

For 16 yrs I used pain meds with very little problems. I took higher doses then most. Some people think if u weight 100 lbs u shouldn’t need the same dose as a 200 lb man. I sometimes vacation from one med to another for a month or two then go back . This helped to keep doses from getting higher and higher. Worked for me. I took my meds every 4 hours. i lived a pretty good life. Could work clean house and care for the kids. Do my community service. Felt pretty good about myself. Then last yr around this time it all went down hill. Only allowed to use meds every 6 hrs and at half the dose. Then no one would fill my scripts because my drs office was 40 miles from my home. For one yr I got my meds by mail or fed ex. That really sucked waiting and waiting for my meds to come. Then Aug 21 2014 I got that letter from my dr. Dropping me as a patient after 16 yrs. now I have nothing. I suffer everyday every hour every min. I can’t sleep I can’t function. I wake up everyday wishing I hadnt. Why didn’t I just die? I never thought this would happen to me never never but it did. I almost did kill myself two weeks ago but I don’t want to do that to my son. The pain it would cause him. What is my future don’t know? I did get lucky a couple days ago and found an old pain patch from 2008. Worked great. Don’t want to hear anything about it being expired nor do I suggest this to anyone else. What did I have to lose? I got to be a person again for a few days.got some stuff done. Made me feel better about myself. I smiled and got some sleep. I know that my life has to have some kind of pain management or I will kill myself. I would like to have my old meds back but those days r gone now. Medical marijuana is now my only hope because the pill problem keeps getting worse. I need that hope. I don’t want to die but I can’t live with this nerve pain. At the city hall meeting for mmj those people against talked about pain meds and pot as one and the people that used them r just the scum of the earth.the looks I got. I am sick not an addict or a bad person. I am a good caring person and didnt deserve the looks I got. I hope this doesn’t happen to anyone else in this group. But I don’t see things getting better only worse in this state of FL. This group keeps growing more groups r popping up. Sorry to say but we r at war. I know how the Jews felt when Hitler came to town. People,here in FL Pam Bondi is way ahead in polls. Why she is a monster. I have new found hope from younger people voting and or getting involved in their government. But this too might take some time. Got to vote. Talked to over 50 kids yesterday at the mall about voting this coming election.they can make things better for us so u better treat these kids with respect. They r our future

WELL SHIT!!!! I JUST GOT OUT OF ICU FOR TRYING TO KILL MYSELF BECAUSE IM SO TIRED OF HAVING UNMANAGED PAIN TO BEGIN WITH HERE IN LOVELY FLORIDA……GOOD THING I HAVE A BACK UP PLAN CAUSE IM NOT DRINKING CHARCOAL AGAIN!

http://www.news-press.com/story/news/crime/2014/09/08/death-investigation-at-groves-rv-park-in-fort-myers/15280035/

A husband and wife were found dead at their trailer Monday at the Groves RV Resort on John Morris Road, apparently the victims of a murder-suicide.

The Lee County Sheriff’s Office responded to unit #100 in the resort at 16175 John Morris Road at 8:30 a.m. Monday.

The sheriff’s office report said the response was in reference to a male caller advising the LCSO that he and his wife “could no longer stand the pain and that they were leaving.”

 We SHOULD BE spending our time trying to take care of our pain !!!  I don’t think heroin addict’s spend that much time running around looking for it on the streets !!!
I ALMOST HAD TO go that route … Because of WAY Too much pain …  With absolutely no pain relieving medication  Better off …going to the streets eh ???
No judgements or rationing on the streets !!!  No wonder we turn to the streets for our necessary/life saving medication !!! Is that their agenda ???
Or just wait till we kill our selves because the pain is too bad ???  Kinda like genocide by suicide ?!?! It’s just unacceptable !!!

Just can’t do this anymore

I am done. Fed up of pain. Fed up of drs and people screwing my life up. Making me live in agony for no reason when they have the power to help. I only ever go to hospital when there is no other choice, when I am in a full blown life threatening crisis. I only ever cry out for support when I am at the end of my rope. But now that rope has snapped. Can’t keep asking for help and support and being rejected by everyone again and again. It is in humane to be in this much pain, it is cruel. I don’t know how much everyone expects me to deal with all the time but I am DONE. I am not living like this anymore.

I’m about done with living. This isn’t living and I hate the quality of so called life I have. This whole thing has thrown me into a fibro flare on top of my back pain. I hurt so bad now I want to die.

 This is a debate question. Not a plan of action !!!!   When is it okay to give up?  When is it okay to want to stop this constant pain?  My wife says it’s selfish for anyone to contemplate taking their life but I think it’s selfish to make someone live like this Every day …..day after day after day.  Today is not a horrible day. Today is an okay day. This is a debate question. Not a plan of action !!!!

 Maybe I shouldn’t ask this, but I’m absolutely at my end. Feel free to message me if you don’t feel comfortable here. I need pain meds, BADLY. I can’t go on much longer this way. I contemplate suicide daily. I’m not a good mother. Or wife. Or friend (which I’ve lost most because the pain makes it unbearable to go out and be social). I can’t work much anymore, which is putting a huge financial and mental/emotional strain on my poor husband. I can barely keep up with my housework either. I feel like a 30 year old failure. My doctor took me off of the one thing that helped me, tramadol. Since then I’ve rapidly gone down hill.

 I bet no one would care if I died, so why not get it over and done with, I mean no one wants to help me. So why bother with life. I’m in agonizing pain daily. Im a looser now and always will be and I drive people away so dont bother being my friend because ill probably make u hate me like I do with everyone else.

 My wife has really been struggling in the last few months. This month has especially been difficult. She has stated many times that her fibro is getting worse. She has ran out of her pain meds and became very depressed. Yesterday she tried to kill herself. I found her face down on her bedroom floor. She had overdosed on other medications and was barely conscience. Ambulance took her to er, after 5 hours a private room. She finally became alert at 11pm enough to answer questions. She was transferred to an ICU last night and today at 5pm transferred to another hospital to deal with the depression.

 I know it is heartbreaking to miss these things and see the disappointment on their faces and people and family want to judge me because I have decided to end my pain on my dad’s bday and are making preparations to do so then I do not have to face begging doctors for enough ends that don’t even touch my pain and be treated like a criminal because I have multiple health issues. I give up

 http://www.infowars.com/i-am-sorry-that-it-has-come-to-this-a-soldiers-last-words/

This is what brought me to my actual final mission. Not suicide, but a mercy killing. I know how to kill, and I know how to do it so that there is no pain whatsoever. It was quick, and I did not suffer. And above all, now I am free. I feel no more pain. I have no more nightmares or flashbacks or hallucinations. I am no longer constantly depressed or afraid or worried

I am free. I ask that you be happy for me for that. It is perhaps the best break I could have hoped for. Please accept this and be glad for me.

 I have a family member who has been in excruciating pain for years, surgeries and injections made it worse. The only thing that gave him the slightest relief was methadone. Well, insurance changed their rules and would not pay anymore, so they have been paying out of pocket. Sunday night he snapped, couldn’t take it anymore and took his life. Why am I telling you? His family is falling apart.

 Hey everyone, I am xxxxxx, 33 years old RSD both legs from thigh to toes, spreading to my hands and calves. I am the most depressed I have ever been, I lost my job, Im a nurse, nothing bad, they were just ridding themselves of Per Diem nurses so I took that hit. I am a single mother of two beautiful girls, 4 years old and 19 months old. My car is about to die, my pain is incredible and nothing seems to work,my hair is falling out root to tip in clumps, I cant stop crying, all I need is a hug. It is so hard to wake up every day and be in this horrific pain. Im out of options, I don’t have any fight left in me,im done with this.

 i am seriously considering participating in Doctor assisted end of life ..reason i can’t take this pain anymore.. It’s not fair for my wife to see suffer on a daily basis.. we don’t have children.. I understand such bill is directed to terminally ill..I will find a mental health provider who will support my decision.. No body cares!.. I reach out to the medical community they use me for $$$ i am referring to surgeons and the legal community could care less.. I guess my ethnicity as a latino in spite of my american heritage is not worth the effort.. It’s not just the arch problem i have a torn theal sac and my orthopaedic surgeon has abandoned me completey.. Sure my wife’s insurance has made him rich along with my medicare due to Permanent disablity.. let’s face it.. the medical and legal community would see me as a total loser..If i hit the lottery or had resources life would be totally different in spite of my pain..I am sick and tired of the bullshit and pain that i endure each and every day…

 Last night a 19 year old friend from Key West died. Pain medication overdose how sad.

 http://www.rawstory.com/rs/2014/11/mich-medical-marijuana-card-holder-commits-suicide-after-police-witch-hunt-over-pot-butter/

 This weekend has been awful. I lost 2 good friends. One died of a heart attack and the other committed suicide pain level is out of the roof

 I just want to die, then I will be in peace no more pain!

Have anyone of you got to the end of the rope and want to let go. No more pain, i wouldn’t in my wildest dreams wish the amount of pain im in on my worse enemy. There is days i pray for god to end it. in sick and tired of being sick and tired. all the meds im on even meds for depression are not helping.i cant sleep, sit, stand, walk w/o being in major pain. i need help i cry myself to sleep the nights i do sleep. im at my max by the DEA law idk what else to do

 Sxxxxx  hung herself Christmas morning. She could no longer take the pain. She tried for a year and a half. She lost her job and had to move in with her son. She spent her last months home bound. She was very scared and alone. The pain was bad enough where she needed help getting into the bath…
Everyone please think of her today. This could be any one of us….
How much can you take? It’s not like she could put the pain away in a drawer for a while. She couldn’t just take a vacation from it. It caused her daily severe panic and fear of leaving the house…Or thinking of the future. She left no note …  12/28/2014

My late wife Karen lost her battle to Chronic Pain via suicide. I’d like to find out more about the (Cake) movie?

At around 330 am my cell phone rang and when your phone rings at that time it’s not going to be good, a very good and close personal friend of mine had been found unresponsive in her bathroom by her hubby, one of my best friends and how I met her actually, he thought maybe she had a heart attack and called 911. They get there and get her to the hospital had to shock her 5 times before they called it. Not knowing the reason they had to run to screens and do an autopsy. She was a chronic pain patient who her new PCP told her she was to young to be experiencing that kind of pain and sent her to a Psychiatrist early this week who was very nice and respectful to her and gave her phych meds and a sleeping pill. Her new Dr being a yutz that she is cut her off of her pain meds accept topomax and a muscle relaxer, this down from oxycodone and other meds. She committed suicide early this morning. Her daughter found the note along with all her personal papers including a living will that was DNR, hospital ER staff is not to blame nor the EMT’S because it has not been notorized as of yet. But this Doctor, boy this Doctor she is going to be meeting my lawyer friend I went to High School and some College with and if he can win a case before the supreme court he can kick this Doctors ass. I will also be calling the Bishop Cupich and a very old friend Cardinal Timothy Dolan who started out as a Priest and the Bishop in Milwaukee to get her a dispensation to be buried in consecrated ground and to be able to have her mass and funeral at her Church. So after typing all of this it was to say we have lost another one unable to bear the pain anymore. No she wasn’t in this group she is from Chicago area.

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COURT UPHOLDS SETTLEMENT BLUE CROSS

CRUCIFIED ON THE BLUE CROSS: JEWISH, BLACK, BROWN, AND WOMEN PRACTITIONERS CONFIRMED DISCRIMINATION UNITED STATES DEPARTMENT OF JUSTICE vs. NEIL ANAND ( THE 3rd. DOSE)

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HOWARD ADELGLASS, MD
NOW SERVING FEDERAL 12 YEARS PRISON Practicing Medicine while JEWISH PRE-COG

ALLEGATIONS OF 3RD REICH NAZI IDEOLOGIES IN U.S. HEALTHCARE PROSECUTIONS SPARK PUBLIC CONCERN AS TO THE FINAL SOLUTION IN MEDICAL PAIN CARE TREATMENT ( THE ADELGLASS PAPERS, “1st DOSE” )

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WHO releases guidelines on chronic low back pain

https://www.who.int/news/item/07-12-2023-who-releases-guidelines-on-chronic-low-back-pain

The World Health Organization (WHO) is releasing its first-ever guidelines on managing chronic low back pain (LBP) in primary and community care settings, listing interventions for health workers to use and also to not use during routine care.

Low back pain is the leading cause of disability globally. In 2020, approximately 1 in 13 people, equating to 619 million people, experienced LBP, a 60% increase from 1990. Cases of LBP are expected to rise to an estimated 843 million by 2050, with the greatest growth anticipated in Africa and Asia, where populations are getting larger and people are living longer.

The personal and community impacts and costs associated with LBP are particularly high for people who experience persisting symptoms. Chronic primary LBP referring to pain that lasts for more than 3 months that is not due to an underlying disease or other condition – accounts for the vast majority of chronic LBP presentation in primary care, commonly estimated to represent at least 90% of cases. For these reasons, WHO is issuing guidelines on chronic primary LBP.

“To achieve universal health coverage, the issue of low back pain cannot be ignored, as it is the leading cause of disability globally,” said Dr Bruce Aylward, WHO Assistant Director-General, Universal Health Coverage, Life Course. “Countries can address this ubiquitous but often-overlooked challenge by incorporating key, achievable interventions, as they strengthen their approaches to primary health care.”

With the guidelines, WHO recommends non-surgical interventions to help people experiencing chronic primary LBP. These interventions include:

• education programs that support knowledge and self-care strategies;
• exercise programs;
• some physical therapies, such as spinal manipulative therapy and massage;
• psychological therapies, such as cognitive behavioural therapy; and
• medicines, such as non-steroidal anti-inflammatory medicines.

The guidelines outline key principles of care for adults with chronic primary LBP, recommending that it should be holistic, person-centred, equitable, non-stigmatizing, non-discriminatory, integrated and coordinated. Care should be tailored to address the mix of factors (physical, psychological, and social) that may influence their chronic primary LBP experience. A suite of interventions may be needed to holistically address a person’s chronic primary LBP, instead of single interventions used in isolation.

The guidelines also outline 14 interventions that are not recommended for most people in most contexts. These interventions should not be routinely offered, as WHO evaluation of the available evidence indicate that potential harms likely outweigh the benefits. WHO advises against interventions such as:

• lumbar braces, belts and/or supports;
• some physical therapies, such as traction (i.e. pulling on part of the body);
• and some medicines, such as opioid pain killers, which can be associated with overdose and dependence.

LBP is a common condition experienced by most people at some point in their life. In 2020, LBP accounted for 8.1% of all-cause years lived with disability globally. Yet clinical management guidelines have been developed predominately in high-income countries. For people who experience persisting pain, their ability to participate in family, social, and work activities is often reduced, which can negatively affect their mental health and bring substantial costs to families, communities, and health systems.

Countries may need to strengthen and transform their health systems and services to make the recommended interventions available, accessible and acceptable through universal health coverage, while discontinuing the routine delivery of certain interventions. Successful implementation of the guidance will rely on public health messaging around the appropriate care for LBP, building workforce capacity to address chronic low back pain care, adapting care standards and strengthening primary health care, including referral systems.

“Addressing chronic low back pain requires an integrated, person-centred approach. This means considering each person’s unique situation and the factors that might influence their pain experience,” said Dr Anshu Banerjee, WHO Director for Maternal, Newborn, Child, Adolescent Health and Ageing. “We are using this guideline as a tool to support a holistic approach to chronic low back pain care and to improve the quality, safety and availability of care.”

LBP affects life quality and is associated with comorbidities and higher mortality risks. Individuals experiencing chronic LBP, especially older persons, are more likely to experience poverty, prematurely exit the workforce, and accumulate less wealth for retirement. At the same time, older people are more likely to experience adverse events from interventions, reinforcing the importance of tailoring care to the needs of each person. Addressing chronic LBP among older populations can facilitate healthy ageing, so older persons have the functional ability to maintain their own well-being.

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The following article is from Dr. Daniel A. Hussar, Ph.D. who is a retired professor from the Philadelphia College of Pharmacy and produces a monthly newsletter about pharmacy issues starting back in 2006. https://pharmacistactivist.com

Dan’s and my path crossed about a decade ago when one of his former students, Joe Zorek, who was suing CVS over EEOC, ADA and Whistleblower violation. and Joe reached out to me to help him spread the word about his lawsuit via my blog.

Joe was able to get CVS to settle without going to court, but while the terms of Joe’s agreement with CVS was confidential. In talking with Joe back then, Joe was very happy with his settlement.

Pharmacy Concerns are Receiving Unprecedented Media Coverage: Synergies and Momentum can be Achieved!

https://pharmacistactivist.com/2023/November_2023.shtml

Media coverage of pharmacy-related issues during the last year has been extensive. The high cost of drugs has been a long-standing concern that continues, but much of the recent coverage has focused on medication errors, staffing and workplace conditions that cause moral injury to pharmacists and increased risk of errors for patients, anticompetitive practices of the health insurance companies with their PBMs and pharmacies, the domination of chain stores in community pharmacy and the decline in numbers of independent pharmacies, the increased number of pharmacy deserts, the fragmentation in the medication distribution system (i.e., local community pharmacy, mail-order pharmacy, specialty pharmacy), and the reduction of personal communication with and counseling of patients.

Media attention to these multiple issues is often initiated because of a harmful medication error. Although this coverage may focus on an experience in a single pharmacy that may also identify the pharmacist responsible for the error, the publicity is a blemish on the reputation of our entire profession. However, an increasing number of reporters are looking for explanations and underlying reasons for an error, and discovering there are many contributing factors such as corporate policies/metrics and understaffing. As much as we may dislike seeing a pharmacy error publicized, the more extensive coverage that reveals the error-prone circumstances under which many pharmacists work is of value to our efforts to increase awareness of and reform the pharmacy practice system. Some examples of the recent media coverage are provided in the following discussion.

USA TODAY

“Prescription for disaster: America’s broken pharmacy system in revolt over burnout and errors” is the title of the first-page story in USA TODAY on October 26. Written by senior investigative reporter Emily Le Coz, this commentary provides excellent comprehensive coverage that identifies numerous factors that contribute to the stressful pharmacy workplace challenges and the occurrence of errors. She initiated her investigation upon learning of a dispensing error that harmed a young child. At each stage of her investigation, she discovered one problem after another that result in the “broken pharmacy system” and the increased risk of errors. Excerpts of her article are provided below:

(Editor’s note: The strategy of CVS and others against whom lawsuits are filed when there is no question that harm was caused by an error, is to quickly reach a confidential settlement in an amount that is likely just a small fraction of what might have been obtained if the lawsuit had gone to trial).

Numerous pharmacists told USA TODAY that errors are not consistently reported – even internally. Small mistakes and those caught early are routinely hidden.

Even when they do report potentially fatal errors, some pharmacists said, no one from their companies investigates how they occurred or makes changes to prevent them from repeating.

Pharmacists are personally liable for medication errors and risk fines, discipline and loss of license if investigated and found responsible by their state board. Many told USA TODAY they get little or no support from their company when mistakes happen, even if the conditions imposed by those companies contribute to those errors.”

(Editor’s note: This shocking statement by CVS attorney Stilling demonstrates how the company’s priority is to protect its own interests while making their pharmacists vulnerable to disciplinary action. It should be widely communicated throughout our profession as a warning about the lack of support and potential consequences for pharmacists who work for certain corporate employers).

Ordinarily I would not include such extensive excerpts from another publication about situations that are so well known to pharmacists and that many are personally experiencing. However, what I have included is just a fraction of the USA TODAY coverage that also includes commentary on “Pharmacists bleeding, crying, working alone,” as well as issues such as pharmacists leaving the profession and plummeting enrollments at many colleges of pharmacy.

Emily Le Coz has provided exceptional coverage of the risks for patients and the concerns of pharmacists in her report, and also very effectively identifies and connects the multiple factors that create and exacerbate the current challenges. Although her report focuses on problems, it is not until the problems are well understood by the public and our legislators that our profession will be effective in developing and implementing solutions. I encourage you to access and read the entire report, and use the coverage of her objective “outside” observations to support your personal relevant experiences in messages with your community and local media.

The Ohio Capital Journal

Over a number of years, Marty Schladen has provided extensive coverage of pharmacy-related issues for the Ohio Capital Journal and previously for the Columbus Dispatch. His investigations were important in determining that in 2017, PBM middlemen and “secondary middlemen” charged Ohio $224 million more for drugs dispensed to participants in the Ohio Medicaid program than they paid pharmacies. The Ohio attorney general filed lawsuits that resulted in large settlements with certain of the middlemen (please see the August 2023 issue of The Pharmacist Activist).

Schladen has recently investigated and published in a series of reports about numerous errors and violations at CVS stores that were documented in Ohio Board of Pharmacy inspector reports. The Ohio Board held meetings on November 7-8 and Schladen’s excellent coverage and selected excerpts include:

November 8, 2023: “CVS disciplinary hearing before Board of Pharmacy begins.”

November 9, 2023: “Ohio pharmacy board members seem skeptical of CVS claims.”

November 30, 2023: “Still more Ohio CVS pharmacies accused of staffing-related problems.”

Marty Schladen understands and clearly articulates how pharmacy workplace conditions, errors, and violations are related to the policies and compensation/economic practices of PBMs that increase the risk of errors for patients, moral injury for pharmacists, and the financial survival of pharmacies. His recent commentary, “Pharmacy middleman grants huge bonuses for winning business meant to help the poor,” (November 17, 2023) begins:

Numerous other publications have also recently reported on the concerns of pharmacists and the risk to patients that result from the corporate dominance of pharmacy and other areas of health care. As examples, recent articles in The Wall Street Journal address issues about PBMs, health insurance companies, and pharmaceutical companies:

The possible merger between Cigna and Humana, which are already among the largest health insurers, has the potential to further reduce competition and increase corporate influence/control of the healthcare system. If the companies’ discussions progress in this direction, a merger would probably be challenged by the Federal Trade Commission (FTC) which is already investigating anticompetitive actions and programs of merged/acquired healthcare companies that were previously approved. There is bipartisan interest and concerns regarding the issues being addressed by the FTC, as well as legislative proposals designed to correct current problems. However, we must never underestimate the ability of the corporations such as PBMs to identify and exploit loopholes in any legislation and manipulate them to their advantage. This makes it all the more important that the public, legislators, and government officials have a clear understanding of the present concerns and consequences for the purpose of constructing legislation and taking actions that will be most effective in providing impactful reforms of our current healthcare system. If substantial reforms are to be achieved regarding pharmacy-related issues, our profession must give a very high priority to assuring that the public, legislators, and other decision-makers have a full understanding of our concerns and their risks/consequences, as well as the urgency for reform. It is in this direction that investigative reports of Emily Le Coz, Marty Schladen, and others are of great value in increasing the awareness and understanding of the public of the issues that place them at risk of harm.

Building momentum

Emily Le Coz’s investigations involved interviews with numerous pharmacists which increased the scope and depth of her coverage. Among those whom she interviewed are Michael Hogue, CEO of the American Pharmacists Association (APhA), and Doug Hoey, CEO of the National Community Pharmacists Association (NCPA). They are the leaders whom the media contact at an early point in their investigations of pharmacy-related issues, and they have been widely quoted in recent media coverage. These interviews, as well as those with other pharmacists have great benefit not only for increasing the awareness of the public of our concerns, but also their awareness of our associations and their programs and activities which are of importance for the public. The formidable challenges continue and may seem impossible to resolve, but I am impressed and encouraged by recent actions of our associations, as well as many individual pharmacists.

In addition to their support for pertinent legislative proposals, the associations’ concerns about the anticompetitive actions of health insurers and PBMs have been widely communicated. At its annual meeting in October it was announced that NCPA is working with three law firms in creating a limited liability company called TRUST LLC (www.fightPBMs.com), which will investigate and, when appropriate, litigate or arbitrate on behalf of community pharmacists to recover coerced price concessions (DIR fees) which have been assessed by PBMs and insurance plans and appear to be in violation of federal antitrust law and state contract laws. It has also been recently announced that Matt Osterhaus of Iowa is the lead pharmacist in a class-action lawsuit against CVS Health, CVS Caremark, and Aetna.

The APhA has established several programs to document unacceptable workplace conditions and to support the well-being of pharmacists. CEO Michael Hogue has recently stated that: “The APhA has been focused on longer-term fixes, and what we’ve heard loud and clear is we need to focus on the acute problems. That’s what we are going to do.” Hogue has met with CVS pharmacists who participated in the walkout of numerous CVS stores in the Kansas City area in protest of understaffing and stressful working conditions. The actions of these courageous pharmacists have resulted in wide media coverage and has provided the impetus for subsequent walkouts and initiatives to start a pharmacy guild. On October 30, Michael Hogue released a statement regarding the challenges for pharmacists, and excerpts are provided below:

This is, by far, the strongest and most direct position I have seen from APhA regarding the challenges that threaten future opportunities and accomplishments in our entire profession. Pharmacists in every area of responsibility must support these positions, and synergies can be achieved by close working relationships with media personnel in increasing public awareness of the concerns that place them at risk.

We must build on the momentum that currently exists!

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This article was published in DRUG STORE NEWS, which is a industry journal. Many in the medical care industry is expanding their scope of services that they provide under one corporate banner. This is known as vertical integration.  While this article is sprinkled with the term “pt care”.  I have highlight some of the text from this article. That suggests to me, this whole new medical care model, is CVS’ intentions to attempt, as much as possible, once any part of CVS Health system cares for a pt’s health needs that they will refer the pt to other parts of the CVS Health system for generating additional revenue for CVS. By having their own employees recommend/prescribe additional health services, that parts of CVS Health provides.  I have stated many times before, that our entire healthcare system is nothing more, nothing less than a FOR PROFIT BUSINESS.

CVS launches new pharmacy reimbursement model, brand for health services segment

https://drugstorenews.com/cvs-launches-new-pharmacy-reimbursement-model-brand-health-services-segment

CVS is introducing CostVantage and Caremark TrueCost to drive aligned incentives and deliver a more transparent and sustainable reimbursement model.

CVS Health introduced a new pharmacy reimbursement model, and brand for its health services segment that showcases continued growth opportunities for its businesses.

CVS Pharmacy also announced CostVantage, a new approach that evolves the traditional pharmacy reimbursement model and brings greater transparency and simplicity to the system. CVS CostVantage will define the drug cost and related reimbursement with contracted pharmacy benefit managers and payors, using a transparent formula built on the cost of the drug, a set markup and a fee that reflects the care and value of pharmacy services. These changes also help ensure that CVS Pharmacy locations will continue to be a critical touchpoint for consumers to access affordable health care in their communities, the company said.

“We are successfully executing on our strategy to advance the future of health care while unlocking new value for consumers,” said Karen Lynch, president and CEO of CVS Health. “The combination of our businesses, and the key growth areas we have invested in, drive our ability to lower the total cost of care, improve health outcomes, and deliver on our commitments to our customers, consumers, and shareholders.”

“We are leading with an approach that will shift how our retail pharmacy is compensated by implementing a more transparent and sustainable model that fairly aligns pharmacy reimbursement to the quality services we provide,” said Prem Shah, executive vice president, chief pharmacy officer and president, pharmacy and consumer wellness at CVS Health. “It provides our PBM and payor clients a foundational step towards more pricing clarity for consumers.”

CVS Pharmacy plans to launch CostVantage with PBMs for their commercial payors in 2025, working together to ensure a smooth transition.

The company said that following on from the launch of its Choice Formulary program earlier this year, CVS Caremark today introduces TrueCost, a model innovation that offers client pricing reflecting the true net cost of prescription drugs, with visibility into administrative fees. Simplified pricing will help consumers be confident that their pharmacy benefit is providing the best possible price and will allow members to have stable access to its national pharmacy network. Through this approach, clients will have the flexibility to choose a pharmacy benefit model that works best for the unique needs of their members and plan, and CVS Caremark TrueCost provides another valuable option for them. CVS Caremark plans to launch CVS Caremark TrueCost in 2025.

To help demonstrate the connection and convenience CVS Health uniquely delivers, CVS Healthspire will be the new branded name for the company’s Health Services segment, including Caremark, Cordavis, Oak Street Health, Signify Health and MinuteClinic. The groups within CVS Healthspire will continue to focus on integration across the company’s assets to deliver connected patient care, pharmacy benefits and innovative provider support solutions in communities across the country, making expert care simple, more accessible, and more affordable. 

The CVS Healthspire brand will begin to roll out publicly this month and advance throughout 2024. Consumers will initially see “Part of CVS Healthspire” appear on select CVS Health care delivery offerings across digital and physical assets as the company continues to create an integrated ecosystem for patients.

“Delivering care in a more integrated way – especially for complex patients with chronic health conditions – improves health outcomes and the patient experience,” said Mike Pykosz, CEO of Oak Street Health and interim president of Health Care Delivery. “We are already seeing the benefits of our value-based model to lower the total cost of care for customers, clients, and patients, and we believe we will build on these results as we more fully integrate with our core businesses.”

While CVS Health’s business segments continue to be successful and profitable on their own, there is a sizable opportunity to continue strengthening these connections and create incremental value for the overall company, CVS Health said.

[Read more: CVS Health report highlights need for expanded role of retail pharmacists]

CVS Health provided the example of the recent improvement of Aetna’s Medicare Advantage Star Ratings. In just a year, by leveraging the power of the company’s cross-enterprise assets and executional excellence, Aetna was able to achieve 87% of their members in four star plans or better for the 2025 plan year, a recovery from 21% in the previous year, the company said.

“This achievement was due to the work across our Aetna, CVS Pharmacy, and CVS Caremark colleagues. Even more important than our ratings, these teams worked together to help members improve medication adherence and overcome barriers such as costs and transportation,” said Lynch. “Our strong performance in this area shows how we can quickly unite our businesses to achieve important common goals.”

CVS Health interim chief financial officer Tom Cowhey today will detail the company’s 2024 financial outlook, capital deployment strategy and long-term outlook and growth targets. The company’s unique combination of assets provides CVS Health with clear opportunities for long-term outperformance, including through Medicare Advantage margin recovery, incorporating Star Ratings, starting in 2025; CVS CostVantage, the company’s new retail pharmacy pricing model; increased patient enrollment in Oak Street Health; expanded product offerings through Signify Health; and enhanced growth in core businesses from new offerings in healthcare delivery.

“By broadening our portfolio of integrated products and services, we expect to create a path to sustainable, profitable growth,” Cowhey said. “Our powerful cash generation capabilities will support our strategic goals, prudent capital deployment, and attractive return profile – while also providing opportunities for meaningful long-term outperformance.”

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Bossier City CVS pharmacy shut down amid DEA investigation

https://www.shreveportbossieradvocate.com/news/bossier-city-cvs-pharmacy-shut-down-amid-dea-investigation/article_30b06a92-9399-11ee-befa-53809e1d2b32.html

The CVS pharmacy location on Barksdale Boulevard in Bossier City,LA is not serving patients amid a Drug Enforcement Administration investigation.  

The location’s pharmacy is closed as DEA agents and Bossier City Police are on the scene.

Representatives of CVS have not yet responded to requests for comment.

This is a developing story and will be updated as more information is discovered. 

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I find this article while starts out interesting and ends up with a Dr. Inmaculada Hernandez, Ph.D. that starts overstating what pharmacies and wholesalers make on supply side of the prescription mark. According to this Dr’s professional information on LinkedIN https://pharmacy.ucsd.edu/faculty/hernandez. Apparently she got her Ph.D. in 2017, suggesting that she has only signed the back of a paycheck, unlike those – like me – who have been owned and operated their own business. Over the years, I have signed the front side of a lot more paychecks than I have just the back side of a paycheck. In our pharmacy’s peak years, I was signing nearly 500 paychecks per year.  Then started addressing the mark-up/gross profit of wholesalers and pharmacies, does someone who has never owned/operated a business, have a clue about overall business expenses and producing/managing a profitable business? The above graphic gives an example of the gross profit of various parts of the Rx distribution system.  Wholesalers are showing a GROSS PROFIT OF 2% and Pharmacies of 3%. The Insurance/PBM had a gross profit of 46%. Those two are lumped together, because the top FIVE PBM’S are owned by insurance companies.

The typical pharmacy has a underlying cost of $12-15$ in fixed overhead per Rx.  That covers rent, utilities, insurance, payroll and overall cost of operating a business. For a pharmacy to stay in business the final cost of Rx should start with $15 PLUS the cost of the medication. For some very inexpensive generics, the gross profit the pharmacy shows, for the uninformed could appear to be extremely high. The last independent pharmacy in an adjacent county to ours, closed down early this year – after being open for 70+ yrs – because the pharmacist owner stated in the media that the PBM’s were paying less than it cost her to buy the medication from the wholesaler on 50% of the prescriptions that she filled.

I wonder why this particular “expert” did not STAY ON TOPIC in the testimony before this Senate Committee? But now the Senators on this committee, got a very inaccurate information about some of the costs/profits within the Rx medication distribution system.

US drug shortages are forcing ‘impossible choices’ for Americans, experts tell Senate committee

https://www.cnn.com/2023/12/05/health/us-drug-shortages-forcing-impossible-choices/index.html

As director of the Lymphoma Clinical Research program at M.D. Anderson Cancer Center in Houston, Dr. Jason Westin regularly witnesses the power of lifesaving cancer drugs. But because generic cancer drugs are often in shortage in the United States, he says, he and his patients have been put in a terrible position.

“The absence of a generic and cheap drug like fludarabine literally can be the difference between life and death,” Westin told members of the US Senate Committee on Finance at a hearing Tuesday.

The committee has been investigating a record shortage of drugs, a problem that’s been going on for decades and is unique to the United States, studies show

Several senators said they’d heard from constituents who are sick or who have patients hurt by these shortages. Sen. Marsha Blackburn noted that the medical center at Vanderbilt in Nashville has had to dedicate more than 100 staff members to managing and mitigating disruptions caused by shortages.

“This is something that is becoming all too common with our providers,” the Tennessee Republican said Tuesday.

The majority of the nearly 200 ongoing shortages – 84% – don’t involve new or novel drugs but rather generics that have been on the market for decades, said Sen. Mike Crapo, R-Idaho. Generics make up 9 of every 10 prescriptions filled in the US, so shortages have a big impact on the country’s health.

“These shortages can inflict drastic harm on massive populations of Americans,” Crapo said. “The average shortage affects at least half a million consumers, forcing them to scramble for viable alternatives or they’ll forgo treatment entirely.”

Many of these generics treat cancer. Fludarabine, a reliable drug used as a part of CAR T-cell therapy, is in shortage now, according to the US Food and Drug Administration. As with a lot of generic drugs used to treat cancer, it has been on and off the list for a few years.

For Westin and his colleagues, patients with rapidly progressing aggressive blood cancers don’t have time to wait for a drug to come back in stock. There’s only a narrow window in which they are well enough to get a potentially lifesaving CAR T-cell therapy, something that works only with fludarabine. There is no alternative, Westin told the committee.

“My colleagues have been forced to make impossible choices, including to choose which patients will be prioritized to receive potentially curative therapy,” he said.

“We know how to treat cancer, but shortages force impossible choices,” he added. “We have drugs that are lifesaving and shortages that are life-threatening.”

A large part of the problem with generics is that they have razor-thin margins and little profit to show for them, so companies often aren’t interested in making them. The number of companies exiting the market to make these drugs exceeds the rate of those entering the market by upwards of 40%, Crapo said.

Much of generic manufacturing gets outsourced to other countries like China and India, which can present geopolitical problems as well as quality-control issues, noted Dr. Inmaculada Hernandez, a professor in the Division of Clinical Pharmacy at the Skaggs School of Pharmacy and Pharmaceutical Sciences at the University of California in San Diego.

“We have a drug supply chain that heavily relies on foreign manufacturing. This is a national public health risk,” Hernandez told the committee.

One solution would be for the government to use value-based payments to incentivize large buyers of generics like pharmacies and hospital systems to purchase medicine from manufacturers with more dependable supply chains, she said.

Makers of generic drugs don’t have to share information about the supply chain, so buyers currently choose based only on price.

To truly end shortages, the Centers for Medicare & Medicaid Services, the nation’s largest purchaser of drugs, would have to be able to buy based on manufacturing quality and reliability, not just on price, said Dr. Marta E. Wosińska, an economist and senior fellow at the Brookings Institution.

“If we start rewarding reliability, manufacturers can maintain actually a higher price point because it’s rewarded, that reliability. Then there’s going to be an incentive that will follow,” Wosińska testified Tuesday.

In other words, more companies would get into the generics business.

Another problem the government would have to overcome, experts testified, is the consolidation of generic drug purchasing among a “small group of very powerful health care middle men,” said Sen. Ron Wyden, D-Oregon. Although there is money to be made in generics, it’s going to these middle men – drug wholesalers and pharmacy benefit managers or PBMs – rather than to manufacturers.

“There are many companies that manufacture generics, but they must compete for the attention of highly consolidated middle men,” Wyden said. Three drug wholesalers control 90% of the nation’s pharmaceutical market, he said.

“The generic manufacturers that are awarded contracts by these middle men do so by offering penny-on-the-dollar prices,” Wyden said.

Offered such low prices, companies don’t earn enough to invest in capacity or in equipment that’s key to making reliable high-quality medicines.

“So you have, in effect, a race to the bottom price for generics that leads to quality control problems and factory shutdowns,” Wyden said.

These “middle men” have also received criticism for driving up drug prices. In a study published Tuesday in the journal JAMA, Hernandez and her co-authors say that PBMs often pay pharmacies “unjustified excessive amounts for generics, as high as 10 times acquisition costs,” which the PBMs then recover through clawbacks rather than passing on to customers.

Hernandez told the Senate committee that of the top 50 generic drugs paid for by Medicare Part D, 16 were marked up 1,000% or higher. For aripiprazole, an antipsychotic drug, pharmacies paid an average of 17 cents per tablet; Rite Aid’s pharmacy benefit manager paid $11.70 per tablet, a 7,000% markup.

“So they end up paying much more than, actually, the pharmacy paid for the drug, let alone the manufacturer got for it,” Hernandez said.

Hernandez said she recommends greater oversight of PBMs. Legislation currently before the Senate would make it illegal for PBMs to engage in “spread pricing,” in which companies charge payers and health plans more for a prescription drug than what they reimburse the pharmacy, and the PBM pockets the difference.

Until there is some kind of legislation that addresses drug shortages, Wosińska and the other experts agreed, they will continue.

“What is vexing about these shortages is that they’re largely avoidable,” Wosińska said.

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I am going out on a limb and make a statement about the DEA and what they are going to do after the public comments on their proposed cuts in the pharma production quotas has closed.

I have been a student and observers of what the Federal bureaucrats have done over the last 40 yrs. The last 10 yrs that we had our independent pharmacy, we had expanded and developed a very sizeable Home Medical Equipment (HME) business.  We belonged to two national associations. One whose membership was independent pharmacy owners and the other was people in the HME business.  Each year, each of these associations had a lobbying conventions. Hundreds of people in business would go to Washington DC. To meet with and lobbying our members of Congress.

After going to Washington DC for several years in a row with all those other people that had businesses in those two industries and talking to our members of Congress and nothing changed. I kind of gave up talking to legislators. One year, we had an appt with one of our Indiana Senators. When we got to his office, we were introduced to his LA (Legislative Assistance). Our Senator was too busy or important to meet with one of his constituents.  This LA, we were told, was the Senator’s point person for industry we wanted to talk about.  It didn’t take but a few minutes talking to her to figure out it would take TWO TEAMS OF Clydesdale HORSES to drag her ass to what she should have known.

Then there was the issue where I mailed a letter to one of our Senator’s Indiana office in Indianapolis. I got back a letter from the Senator’s office stating that he was also AGAINST whatever the issue was. He agreed with my position. A day or so later, I got a SECOND LETTER from this Senator’s office, This letter stated that Senator agreed with me, in being in favor of the same issue.

I quickly became skeptical about how our political system functions. What the politicians lead to believe how things works, has little to do with reality.

Today, one of the chronic painers told me that abt 600 comments on that site, did not show up.  I am not aware of anything in the law that “they” have to accept all comments, nor read any of the comments, nor take into consideration any/all comments when they make their final decision. The whole process seems to be a lot of SMOKE AND MIRRORS.

The DEA as been perpetuating their agenda for 53 yrs. They say no one is above the law, but it does seem that those who enforce our laws can be selective in how they operated within our system.  My crystal ball strongly suggests that there are many within our judicial system and healthcare system are working toward restricting the availability of all controlled meds. Will “bodies” start to pile up from premature deaths and/or suicide from drastic reduction the availability of controlled meds. Could history look back on this period and see all these deaths as a sort of covert genocide?

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