When healthcare providers end up really being healthcare deniers

I got the email below on Jan 1, 2024.  This pt’s story is not a unique issue. Another example of bureaucrats and politicians attempting to “solve” our fabricated opioid crisis by creating a “one size fits all” on pain management.

After having this blog for 12-13 yrs, I have developed a fairly sizeable network of chronic pain pts, chronic pain advocates, and numerous healthcare practitioners.  I shared this woman’s email with a couple of select people that I believed might be able to STEP UP. And one did:

When a pt’s long term medical records mean nothing when seeing a new practitioner

When everything seemed to start to fall into place for this young lady. This young lady’s pharmacist and the mid-level practitioner who was forcing her to reduce her pain meds had to step in to make sure that things were not going to change the way that this mid-level practitioner wanted things to happen. Here is a video this young lady sent that she personally explains what has happened.

Hi Steve,

I have sent you my story before. I am a single disabled palliative care sick patient in Maine. In September of 2021, my doctor and I were targeted by the assistant attorney general, Michael Miller. We think it was for 2 reasons-he was very effective at getting patients disability, testings, procedures, equipment, etc and because I require a high dose of opiates to physically and mentally function. Dr. Lommler believes Michael Miller made a deal with the insurance companies and profited somehow for taking him out. Michael Miller used at least 2 agencies to target, harass, and destroy us. They suspended Dr. Lommler’s license for going over the 100 MME limit on my prescription. However, Maine has a palliative care exemption that allows people (like me) to have access to opiates for pain control and disease treatment options. It also allows us to go over the 100 MME limit. They refused to lift the suspension unless he transferred to a “board approved” facility. He chose to retire because he wanted to stay at his independent office with his 200 complicated and unique patients. They gave neither one of us any due-process! They used backdoor methods and I believe they were illegal! There was a covering LNP seeing me for a year. We tried to find a doctor everywhere in Maine to see me but because of the Opiate Task Force and doctors getting red-flagged for going over the 100 MME limit and being dragged in front of the board, no one would see me. I was forced to transition to the hospital where all of my specialists are. You see, Maine and New Hampshire were the 2 states prescribing the most Opiates so they created a New England Opiate Task Force and sent them to work with the Governor Mill’s administration to red-flag doctors prescribing over the 100 MME limit and drag them in front of the board of medicine! They have forced independent providers to either retire or transfer to a “board approved” facility. These “board approved” facilities all have anti-opiate one-size-fits-all policies. The hospital that I am at has an anti-opiate provider masquerading as a “pain specialist.” She believes Opiates are life threatening and dangerous to everyone. She is force tapering me off all my pain medication! I am complicated and unique-I have multiple health conditions. I had an original medical nightmare that left me with life altering physical deformities and severe debilitating pain. I have Crohn’s disease, vitamin and bone deficiencies, and neuropathy-all of these cause malabsorption so I have to take double doses of all of my medication! I cannot have the conventional pain management treatments because I am allergic to everything and sensitive to anything and I have a prosthetic heart valve. I have Scoliosis and severe Osteoporosis with dangerously low Scores. I am 46 in an 86 year old’s body.
They are stereotyping anyone on opiates as addicts and forcing them off pain medication. The only option they give you is Suboxone-I cannot take this because the side effects would be catastrophic to my body. I had nothing but recovery and progress with my 8 1/2 year stable pain regimen. I was able to semi function independently with a decent quality of life. Since this provider has been force tapering me, I can no longer function independently at all and I have zero quality of life! According to Maine’s own definition and standards, what this facility and provider are doing to me is disability abuse! I tried to contact patient services for an advocate but was told there wasn’t one. The woman I spoke with for 2 minutes, asked me what my concerns were. I explained to her what was happening to me. 2 days later I received a letter stating my concerns were forwarded to the Medical Director and Operations Manager and they agree with the provider force tapering me. They also said there was no medical justification for my pain medication. I filed a public accommodation discrimination complaint with the Maine’s Human Rights Commission but haven’t heard a word since intake months ago! The letter gave an 800 number to call if you disagreed with their decision. It was the board of licensure telling you to submit a complaint. I already filed a complaint with the board of medicine and nurses months ago. So, you have to go to the same people that are red-flagging and harassing doctors going over the 100 MME limit. I won’t hold my breath! These are the same people that asked Dr. Lommler how he didn’t know that I was taking half of my pain medication and selling the other half! Dr. Lommler provided them with 7 1/2 years worth of passed urine screens and passed frequent random pill counts! I wasn’t even allowed to attend or participate into the investigation into my opiate use-I could’ve answered that question myself-I have never misused my pain medication! In fact, I did everything that I was supposed to do! How in the world can I trust they will help me!
Since this provider has been forcing me off my pain medication, I have had sky high blood pressures-202/129, severe bloody noses, I have been discharged from aquatic therapy-which I needed to get into my Crow Walker boot, I am completely dependent on my sons, I have had to quit tutoring for supplemental income, I can no longer walk on my crutches so I am trapped in my wheelchair, and I cannot mentally or physically function! My counselor and former providers have tried talking with this provider but she refuses to listen because she knows best. I had to spend my Christmas in the ER and I am now watching my right leg and foot do exactly what my left leg and foot did in my original medical nightmare. When my body is in severe stress, my multiple conditions play off of one another and wreak havoc on my body. Last time, the severe stress was an allergic reaction to hardware (we didn’t know why at the time, it took years to figure it out). This time, it is force tapering my pain medication! This time, it’s the providers choice to force taper me because of her personal feelings about a medication! Medical providers are supposed to do what is in the best interest of the patient, not what is in the best interest of their personal feelings! I have cellulitis in my right leg and foot with ulcers everywhere! I maintain my left leg and foot with Cuban for compression. I tried to wrap my right leg and foot but it’s not used to being wrapped, and I get continuous Charley Horses. They are intolerable with all of my pain medication being taken away! I have severe PTSD and zero trust in doctors from my original medical nightmare! I never ever wanted to go back to that sick person trapped in a wheelchair, I thought I left it behind for ever! This time, I don’t have a heart valve to lose! I am petrified and profoundly devastated because I worked so hard for 8 1/2 years to recover and progress and now that has been destroyed! I see people helping doctors that have been arrested but what about people, like me, who have been targeted, harassed, discriminated against, and literally going through disability abuse-who tells our story and helps us?
My counselor gave me a brochure for adult protective services and she told me to call because what they are doing to me is discrimination and disability abuse. I called and the lady said there is no process for this situation. She told me that it does qualify but the only thing I can do is file a complaint with the board of medicine and nurses because they are the only entities that have authority and jurisdiction over medical providers. I told her that I already filed complaints but it will take months because they only meet one day a month! I told her my body won’t make it that long and I asked her, “what if I die in the meantime?” She said, “let’s hope it doesn’t come to that but good luck!” WHAT? It’s like a nightmare that I cannot wake up from! I have contacted every politician in Maine and asked for their help. Crickets…I requested assistance from Governor Mills but she doesn’t even think she has to answer to her constituents. I have reached out to every volunteer lawyer’s projects and disability rights groups but they all claim no to have the resources to help me. I have documented, taken pictures, recorded videos, screenshot messages from my portal between her and I, audio recorded my video appointments exposing her discrimination and disability abuse! I cannot find an attorney in Maine to help me. This provider only saw me one time in person! She never looked at any areas causing my pain, she’s not monitoring my vitals or everything that is happening to me, she doesn’t even have the correct MRI’s-she’s going by a 2008 one when I was a normal person and could walk on my own, and she’s retaliating against me for filing a complaint! I need help and I don’t know where or who to go to! I even have an appointment with cancer care, January 23rd. I have MGUS and the blood work markers and symptoms all point to it turning into Multiple Myeloma. I asked her to please pause the force taper until I can get into my appointment. She said, “Oxycodone will not cure Multiple Myeloma so the force taper will continue!” How cruel is that!
I was hoping that you may have some direction or advice to help me. If I knew how to file a civil lawsuit against the hospital and provider, I would do it myself. Since September of 2021, I have had to be my own advocate, case manager, and attorney!
I already missed about 6 years of my sons’ lives because of my original medical nightmare! I can do no physical activity without my pain medication! I really don’t think my body will make it through this force taper! Opiates are literally life saving for me! They knew that I wouldn’t be able to find another doctor to see me and Michael Miller and the board of medicine took 2 doctors from me! The provider force tapering me filed a complaint against the LNP that saw me for a year. In it, she said that she felt compelled because Kaye endangered my life by prescribing these life threatening and dangerous medications. She also accused me of bribing Kaye in her complaint. That is ludicrous-I have never bribed anyone! Kaye made it very clear in her response that no one forced or bribed her. She also made it clear that I was the only patient she ever prescribed narcotics for in her entire medical career! I have been accused of selling half of my pain medication and bribing doctors! I am a law abiding Mainer and American just trying to live my life!
Thank you for taking your time to read my email. You can reach me any time at xxx.xxx.xxxx

most societies/communities have 1 or more agitators, disruptors, false prophets, scammers, traitors, saboteurs and cult leaders

Some believe our country is on the verge of a Civil War, they may be right, but it won’t be a bilateral war like our last Civil War..  Our society has voluntarily divided itself in – for lack of a better description – TRIBES.

The chronic pain community is not all that different from our country of as a whole.

Recently a fellow chronic pain pt who had been advocating for end stage pediatric pts in a large hospital system that has a “no opiate” policy.  All of a sudden the advocated was told that he was no longer permitted to advocate for these end of life pediatric cancer pts.  I suppose that this major hospital system will return to treating these pediatric pts with NSAIDS and Acetaminophen and let them live the rest of their lives in a torturous level of pain.

There are rumors as to who said what and to whom… I am not going to elaborate. However, they know who they are and what was said to cause this to happen.  One can only imagine the deprived mental status of those who have been involved in this.

Some have told me that this tribe of malcontents have monetized chronic pain pts’- personal information  and several other covert processes. I started my blog in 2012 and have tried to motivate and educate chronic pain pts in some ways that they can navigate their way to getting their pain management back.  Some chronic painers have told me that I should charge for my advice.  My Pharmacy degree, license and career has provided for Barb and myself a comfortable retirement.

After this issue with these end of life pediatric pts,  Going forward… I am going to ASK of people that want my advice to make a contribution to one of the four national charities listed below, these are all about THE KIDS… and charities we support.  Maybe in some small way, my advice can help more than just one person/family. 


https://www.stjude.org/ St. Jude Children’s Research Hospital – deals with kids dealing with cancer and/or life threatening health issues

https://lovetotherescue.org/ Shriners Hospital – deals with kids, born with “broken bodies” and birth defects

https://rmhc-kentuckiana.org/ Ronald Mc Donald House – this is near us and just a few blocks from a very large regional pediatric hospital ,3 other major hospitals within blocks, one being a teaching hospital and having the only LEVEL ONE TRAUMA CENTERS for 100 miles and part of a medical university and  helps provide housing for families with kids in the hospital

https://t2t.org/ Tunnel to Towers Foundation – helps get handicapable housing for veterans, first responders with “broken bodies” , families with spouse/parent killed in the line of duty and Gold Star Families



Pts BEING ROBBED at the pharmacy counter and totally unaware of it

According to this, Caremark flipped the Rx to Goodrx, and the pt was charged ~ $46. GoodRx charged the pharmacy a $38.50 “administration fee” and the pharmacy was left with a $16 LOSS and the money that the pt paid at the pharmacy did not apply to their annual deductible.  I saw a video the other day from a pharmacy/pharmacist who has gone to an ALL CASH on prescriptions and he was charging wholesale cost plus $10. Under this example, at such a pharmacy, the pt would have paid $33.86, and this pt would have saved some 30%. CVS Health/Caremark would have made ZERO and the pharmacy/pharmacy would have a profit of $10

Federal Agencies Launch Portal for Public Reporting of Anticompetitive Practices in Health Care Sector

Federal Agencies Launch Portal for Public Reporting of Anticompetitive Practices in Health Care Sector


The Justice Department, Federal Trade Commission (FTC) and the Department of Health and Human Services (HHS) today launched an easily accessible online portal for the public to report health care practices that may harm competition.

The online portal, HealthyCompetition.gov

, allows the public to report potentially unfair and anticompetitive health care practices to the Justice Department’s Antitrust Division and FTC. The launch of the new portal advances the Biden-Harris Administration’s efforts to lower health care and prescription drug costs

and help create more competitive health care markets that are fairer to patients, providers, payers and workers.

“Competition in health care is crucial to ensuring fair and competitive wages across the healthcare sector and affordable and quality healthcare for all Americans,” said Assistant Attorney General Jonathan Kanter of the Justice Department’s Antitrust Division. “Today’s launch of HealthyCompetition.gov

 – a one-stop shop to report potential violations of our competition laws to the Justice Department and FTC – will allow the agencies to collaborate early and often, helping to promote economic opportunity and fairness for all.”

“All too often, we hear how unfair methods of competition and monopolistic practices may be depriving Americans of access to affordable, high-quality healthcare,” said FTC Chair Lina M. Khan. “This joint initiative between FTC, DOJ and HHS will provide a crucial channel for the agencies to hear from the public, bolstering our work to check illegal business practices that harm consumers and workers alike.”

“Americans depend on competitive health care markets to provide quality choices and lower costs for coverage. That’s why we are working to tackle anticompetitive practices in the health care markets,” said HHS Secretary Xavier Becerra. “The Biden-Harris Administration and HHS know it is our responsibility to stop monopolistic, anti-competitive practices that undermine the delivery of health care to Americans. The information provided by the public will help to root out these behaviors.”

Complaints will undergo preliminary review by staff at the Justice Department’s Antitrust Division and FTC. If a complaint raises sufficient concern under the antitrust laws or is related to HHS authorities, it will be selected for further investigation by the appropriate agency. This action may lead to the opening of a formal investigation.

The privacy and confidentiality policies that govern information submitted through the portal, including any personal information members of the public choose to provide, can be found at DOJ Privacy Policy, DOJ Antitrust Division Confidentiality Policy Regarding Complainants and FTC Privacy Policy

HealthyCompetition.gov is the latest effort by the Justice Department, FTC and HHS to promote competition in health care markets to ensure that every American has access to high-quality, affordable care. As announced in December 2023, the Justice Department, FTC and HHS have continued to partner on new initiatives, which included a joint request for information to seek input on how private-equity and other corporations’ control of health care is impacting Americans.

Type of Pharmacy Malpractice

According to this video. It would appear that Dr Dan Laird, MD, JD may represent chronic pain pts who are being discriminated against and denied their prescribed therapy. Go to abt 5 minutes into the video where he talks about Legal/Civil Liberties Violations by pharmacists refusing to provide chronic pain pts with their legally prescribed pain medications.



Chronic Pain Patients Fight Back Against DEA

Chronic Pain Patients Fight Back Against DEA


Dr. David Bockoff’s Pain Patients Are Fighting for Justice!
My name is Kristen Ogden and I advocate for chronic pain patients.
My husband, Louis Ogden, is one of the chronic pain patients I’m talking about.
Consider the fact that Louis has suffered from pain since he was a child.
Some of you already know the background of our efforts to intervene in the case of DEA vs. Dr. David Bockoff. If you don’t, we invite you to go first to https://www.daily-remedy.com/as-i-sat-in-court-watching-the-dea/ and to https://www.daily-remedy.com/a-patients-plea-for-justice/.
If you have pain, or you know someone who does, or fear some day you will have pain, as we all age, then you may want to consider what we’re doing in court.
The why of our cause is straightforward.
We are seeking justice for doctors to use their skills and justice for pain patients who desperately need relief from unremitting pain.
In our fight with the DEA administrator and the relevant courts, we knew we had to retain counsel.
When I first spoke to John P. Flannery, a former federal prosecutor, and special counsel on the Hill, and trial lawyer for decades, Mr. Flannery asked what outcome did we wish.
Without hesitation, I said, individually and collectively we want the right to be let alone, to have access to pain medications for my husband, Louis, and for all of these patients in the same straits. That’s what we want.
Mr. Flannery launched our effort with our full support with a Motion to Intervene in the case of DEA vs. David Bockoff, as “interested persons,” suffering because Dr. Bockoff was cut off summarily from continuing our pain prescriptions.
We hoped to get the prescriptions we needed for our unremitting pain, and to exonerate Dr. Bockoff so he could get back to work caring for his patients.
Prescriptions for controlled pain medications can only be possible if there’s a qualified pain specialist to write the scrips … preferably one who is knowledgeable, compassionate, and who “gets it” about chronic pain and the patients who suffer from it.
We filed the Motion to Intervene, and, as expected, the DEA Administrative Law Judge (ALJ) denied our motion.
The way DEA runs the Administrative Law Court leaves patients with no voice in the situation.
Everything is behind closed doors. There is no public record of what the DEA and its counsel and its administrative judge are doing. We believe that’s a first amendment violation of our right of access to what the government is doing.
Next we appealed.
The next step available to us was to appeal the ALJ’s decision to the U.S. Court of Appeals for the District of Columbia Circuit. So we did.
We filed rounds of briefs and exhibits but we suspect the court hardly read what we said.
We argued to a 3-judge panel the merits of our case.
The judgment of the Appeals Court, issued February 20, 2024, missed the mark entirely.
It truly seems like the 3 judges who sat on this panel in January 2024 didn’t take the time to read the brief, or the prior proceedings, all of which we submitted to the court.
One could easily conclude that the judges really don’t want to “hear” us, no matter our life or death concerns.
In their order they made the amazing claim that we made “no creditable” factual claim when we gave individual bios of our petitioners’ history of pain and treatment.
If we didn’t have so many data points from the past treatment of and indifference to pain patients we might think this was a typo, but it does fit what the government always claims, that pain patients are really addicts.
They clearly didn’t take us seriously, describing a document we submitted as “a series of narratives purporting to be by pain patients or their spouses.”
The Court’s 3-judge order of February 20, 2024 was full of the ways the court “felt” and “believed” our petition fell short, even as the court’s beliefs contradicted the holdings in other cases in the same court house.
It is no exaggeration that the court did not acknowledge the substance, the merits of our concerns, at all.
I have great respect for the law but the best I can say is that the judges seem to be limited in their view of our situation … bound by what’s been called “the bias of settled habit” … a habit of accepting as true what they’ve grown accustomed to accepting without applying themselves to fearlessly face and critically evaluate what’s been presented to them.
The Court – like many others in our “culture” – buys into the accepted trope that opioid pain medications are all “bad” and the people who rely on these medications are also bad – – drug seekers, drug diverters, or drug traffickers.
These prejudices defy the reality that pain, acute and chronic, is real and our bodies can’t curb the pain by our body’s own devices.
So our public policy about pain is based on irrational thought and fear, rather than the findings of medical science. It’s the same irrational fear that has gripped our society for 100 years or more.
The government doesn’t want to address our claim that patients matter and they deserve to be treated as ill and not accepted as collateral damage because of a flawed public policy that is indifferent to our risk of pain, illness, death and possibly suicide.
So what’s to be done? The Court order of February 20, 2024 stated we have an opportunity to petition for rehearing “en banc”… that is, to take our argument to all 15 of the Appeals Court judges participating.
So we – the group of Dr. Bockoff’s patients and their spouses/families who started this effort to intervene – are not finished yet. We want to take advantage of this opportunity to petition these judges to suspend their preconceived bias and their disbelief and instead render their full critical attention to the facts, at last, and to consider what the DEA’s actions have done to this group of patients and to Dr. Bockoff.
We have seen information compromised, laws ignored, and facts side-stepped in this case.
We insist we care about humanity and illness.
This is a chance for the Court to prove that’s what they’re about.
In order to continue fighting for acknowledgement and for access to necessary medical care and medications, we are seeking to raise funds to help cover the additional legal effort that will be required.
Please consider what you may do to help these petitioners. It matters to you if you are or know someone who suffers as they do. If you join our argument, you may be helping yourself – even if you don’t need help now.
Why should you donate to our cause?
There’s a bull’s eye on the lab coat of every doctor who prescribes pain medication.
There are slanders by the government that patients don’t need these drugs, that they are drug seekers, not suffering pain patients.
It’s hard to say what kind of lie is worse but there has to be a lie that is so inhumane it merits a special category.
If the measure of a nation, if the standard of civilization, is how we treat our own, then by that standard, we are failing our nation’s promise in the constitution to promote and provide for the general welfare.
In recent years, the so-called War on Drugs, proclaimed when we were young, and never apparently “won,” has targeted thousands of pain specialists and chronic pain patients, putting doctors out of practice, confiscating their medical practice, taking their assets without due process, and sending many physicians to prison for trying to care for their patients.
Thousands of chronic pain patients are suffering from untreated or undertreated pain.
We need financial help to continue this fight.
• We want to continue legal action to help ourselves and Dr. Bockoff.
If successful, we hope this could set a precedent that would help other doctors and patients.
• DEA’s practices are driven by the same 100-year old irrational beliefs, by misinformation and disinformation and conducted in secrecy, without transparency.
We reject the DEA practice of excluding patients from access to information and from the dialogue.
• The notion that we are merely “purporting” to be pain patients and families seriously and substantially harmed by DEA reveals the false but pervasive prejudice against citizens who suffer terribly.
The bias and stigma against chronic pain patients need to be exposed to the public for what they are … untruths based in irrational fear, misinformation and disinformation. We seek truth and transparency.
• We believe that our constitutional rights are being violated – the rights of doctors and patients – and that we should all be concerned about the fate of our freedom and our rights.
The depth to which our government has stooped to interfere in the practice of medicine and to interfere with the right to privacy and the doctor-patient relationship is inhumane, shocking and terrifying.
You have a chance to help us fight back! No donation is too small.
Whether it’s $10,000, $1000, $100, or $10/month, every donation will be greatly appreciated and will be used to fight this fight.
Donations will be deposited in a dedicated bank account and then transferred to the firm Campbell Flannery P.C. in response to monthly billings!
Please donate today!
We invite you to honor the memories of these Dr. Bockoff patients.
These pain patients suffered from the loss of Dr. Bockoff’s medical care and are no longer with us because of the DEA Administrator’s suspension of Dr. Bockoff’s ability to prescribe them pain medication:
Danny & Gretchen Elliott of Georgia,
Jessica Fujimaki of Arizona, and
Rebecca Snyder of California



When:  Friday May 17, 2024

Time: 09:00 AM – 01:00 PM  CDT

Where the Public sidewalk in front of Express Scripts HQ

Address: 1 Express Way, St Louis, MO














Please share with everyone you know 💚💙


Many patients across the nation are forced or steered to Express Scripts against their will as it is the only option of coverage allowed by the pharmacy benefit manager (PBM) or insurance company. Express Scripts is a PBM and mail order pharmacy. Express Scripts often uses their own PBM to steer patients to their own pharmacy. Patients have faced life-threatening delays, interruptions in treatment, and some have been forced to receive medications such as room temperature medications not stored at the temperatures proven safe by drug manufacturers as the only option of coverage.

Express Scripts also uses their PBM portion of their business to restrict access to medications by restricting medications on the list of covered medications. Physicians are hiring additional staff to deal with long exhaustive obstacle courses to obtain the medications needed for their patients.

Express Scripts has a 1-star rating on the Better Business Bureau that highlights this Pattern of Complaints:

“Better Business Bureau is advising consumers to use caution when considering doing business with Express Scripts. BBB has received a pattern of consumer complaints alleging delays or failure to ship correct prescriptions or medications; failure to accept returns or medications which were shipped in error; failure to issue refunds; debiting credit or debit cards for prescriptions not shipped and poor customer service.”

When patients are so graciously allowed by their PBM to use their local pharmacies, PBMs like Express Scripts also oversee reimbursements to competitor pharmacies & often reimburse competitor pharmacies below their cost, causing closures of local pharmacies in the most underserved rural and urban areas across America.

Upon advocating for regulation, legislation, & protection from these pharmacies, advocates find themselves against one of the wealthiest lobbyist organizations in America, the Pharmaceutical Care Management Association (PCMA) that has in the last year doubled the amount they’re investing in lobbying by the millions. The Boards of Pharmacy also often have strong ties and even members sitting in regulatory positions making it almost impossible for protection & justice. It’s time to demand it! Patients deserve ethical treatment and safe access to their local pharmacies.

Often, many are “too sick to fight” & many pharmacists fear retaliation for speaking publicly about these issues.

This is why we need your voice. We look forward to meeting you there!


You’re busier from open to close, but making less than you did the last year, every year

Imagine filling 7000 Rxs/month and losing money. Filling an Rx Every TWO MINUTES – from opening to closing and losing money!

Small Wyoming Pharmacies Pushed Out Of Business, Say Industry Is Like Mafia


Eric Saul realized a dream of being his own boss in 2019 when he opened a little pharmacy in Casper.

His independently owned pharmacy grew faster than any of the other local ones at the time that were being supplied by pharmaceutical distributor Cardinal Health. By 2024, it was a thriving business, filling 7,000 prescriptions in a month.

“The killer of it was, we grew 20% from January last year to January this year,” Saul told Cowboy State Daily. But despite that growth, “we made 15% less from insurance companies.”

That had both Saul and his employees on this crazy hamster wheel. The faster the business grew, the faster it went nowhere at all.

That’s when Saul decided to close his thriving pharmacy. Despite its popularity, he could see no way to become solvent in the current system, no light at the end of the tunnel.

“It’s just insane,” Saul said. “You’re busier from open to close, but making less than you did the last year, every year.”

Saul’s isn’t the only one facing these issues. He knows of at least five other independent pharmacies across the Cowboy State that have closed in the past year for similar reasons.

Among them is Gene Barbour, who owned the Medicap Pharmacy in Cheyenne. While Barbour said he was ready to retire, part of what drove that decision sooner rather than later was the very dynamic outlined by Saul.

“It’s the reimbursements,” he told Cowboy State Daily. “I can’t tell you how many thousands of scrips over the last few years that I’ve sold for less than the price of a bottle of aspirin over the counter.”

With reimbursements not even covering the price of the drug inside a pill bottle, that left Barbour subsidizing bottles, labels and his employees’ time to fill the prescriptions, not to mention the store’s overhead, like rent and utilities. It all just became increasingly unmanageable.

The entire pharmacy sector is broken, Saul and Barbour say, and small independent shops like theirs, which had hoped to provide an independent service in the marketplace, have no shot at all.

Their stories are just a window into how broken their industry is.

Saving Consumers Money, Or The Fox Guarding The Hen House?

The biggest issue both Saul and Barbour cited is vertical integration in the pharmaceutical industry.

Vertical integration refers to pulling disparate services under one umbrella so they’re no longer provided by separate companies.

It’s happened in a big way in the pharmaceuticals industry. The biggest players are now health insurer, pharmacy, and PBM, all in one.

PBM stands for pharmacy benefit manager. These are companies that started out as a way to make life easier for pharmacies. Without them, pharmacists confront a confusing maze of companies to send benefit claims through, one that would take an entire accounting department devoted only to that.

So PBMs took over that role for pharmacies. And they also played middleman, helping to negotiate lower costs for their customers.

Vertically integrated companies like Express Scripts and CVS contend that also being the PBM has helped them negotiate lower prices for members. It’s also helped them more readily control which drugs go on their lists of available medications, called formularies, to ensure everything on that list is proven safe and effective.

But questions have arisen about the role of PBMs in the marketplace, and that has sparked a Federal Trade Commission investigation into the six largest PBMs. That began in 2022 and is still ongoing.

The six under FTC scrutiny include CVS Caremark, Express Scripts, OptumRx, Humana Pharmacy Solutions, Prime Therapeutics and MedImpact Healthcare Systems.

CVS protest 4 14 24

The Walmarts Of The Pharmaceutical Industry

Pulling PBMs under the very same large umbrella is part of what Saul and Barbour believe has killed any chance of real competition in the sector for independent pharmacies.

“CVS was the major one that caused me to close,” Barbour told Cowboy State Daily. “They owned a large portion of our business, you know, of our customer base. And they have their own pharmacy, they have their own warehouses.”

And they have their own PBM.

“So (CVS) is the insurance company, the PBM and the pharmacy,” Saul told Cowboy State Daily.

With such a large customer base — 40% of the market — that’s made the CVS brand akin to Walmart in the retail sector. They’re big enough to tell independent competitors what reimbursements they must take to become part of serving their customers.

It’s the same dynamic that, for years, has allowed Walmart to tell its suppliers what prices they’ll take to be on the retailer’s shelves. As a result of that, independent retailers often find they can buy products for their stores off of Walmart’s shelves for less than they can buy them direct from a wholesaler.

That had Saul and Barbour losing money on thousands of prescriptions each month.

“I was losing $1.35 on every scrip I filled for (this one) co-op,” he said. “The pills inside the bottle were $1.35 more than the insurance paid. So, I wasn’t paid for that bottle, that label or that lid. Or my pesky staff who want paid, or the light bill, the heating bill, the cooling bill, the floor space. Just for the pills inside the bottle, I was paid less than they cost me sitting on the shelf.

“That’s disgusting.”

Code Of Silence

Talking about the situation publicly though, was dangerous, Saul and Barbour told Cowboy State Daily.

“If I talked negative about an insurance company, I’d get two audits in the next week,” Saul told Cowboy State Daily. “And these audits are $400,000 worth of drugs that takes me two days to print everything out.”

If the audit found even a minor mistake, such as a 28-day scrip where the patient got 30 pills instead of 28, Saul said the insurer could claw back the entire reimbursement, leaving him with no reimbursement at all for dispensing the medication.

And, with all the large insurers now having their own vertically integrated PBMs, independents like Saul and Barbour found they had little choice but to go along.

“Three PBMs now own 80% of the market,” he said. “So, when they come to you with a contract every year, you have no negotiating strength. It’s take it or leave it, and every year it gets worse and worse. Which is interesting, with (consumers) premiums going up and (our) payments going down.

“The only place I can figure it’s going are the pharmacy benefit managers.”

Membership Or Mafia Shakedown?

Saul has been told about strong-arm tactics that force drug manufacturers to pay huge rebates to get their products on the list of medications, or formularies, of the largest insurers.

In fact, that is one of the issues FTC is examining in its investigation, though the federal agency says it’s been difficult to understand that because of a lack of transparency in the whole process.

Saul told Cowboy State Daily he was informed by an employee of one large drug manufacturer that it was being strong-armed to pay $250 million to be on the formulary of one large health insurer.

The stakes for that drug manufacturer were extremely high, Saul added. Without being on the list, the drug manufacturer would get shut out of a huge swath of the marketplace.

While out-and-out kickbacks are not legal, negotiations to lower prices in the form of rebates are legal. But these negotiations have been kept confidential, hidden behind the PBM. Thus, it’s never clear if any of these “rebates” come back to consumers in the form of reduced costs.

From his observations, Saul believes it doesn’t. His own customers’ premiums never went down, he said, while his own reimbursements just kept getting lower and lower.

“They’re making billions of dollars just charging drug companies to be on their formularies,” Saul said. “And PBMs are coming out with record billions and billions of profit every year.”

State Change Stymied

What’s happening to squeeze small independent pharmacies out is happening nationwide, Saul said, and real solutions probably have to also come from that level. But he has been among Wyomingites pushing for changes at the state level that could help in the short-term.

That started a couple of years ago during a budget session. Saul said the Wyoming Legislature seemed to understand what needed to be done at the time, but simply ran out of time to get a bill over the finish line.

“The second year, it did make it past legislators, and then Gov. Gordon line-item vetoed everything out of it,” Saul said.

More recently, lawmakers approved a bill requiring insurers to provide reimbursements to pharmacists for drug prescriptions in a reasonable amount of time.

That bill, Saul said, is just too little too late.

“I mean, I haven’t had a problem with delayed payments,” he said. “So, I’m not sure why we were fighting that battle. I’m usually paid within a month of everything that I dispense except for maybe two insurance companies that probably totaled less than a hundredth of a percent of everything I did.”

Saul is particularly miffed with Gordon’s line-item veto.

“He literally signed a bill that was a title and definitions and of no help to pharmacies,” he said.

Meanwhile, Saul said, Wyoming has lost five independent pharmacies in the last 14 to 16 months.

“The last one was in Cheyenne,” he said. “There was one in Casper, two in Gillette, one in Pinedale. That’s pretty much proof that this is unsustainable.”

Gordon’s Take

A representative of the governor’s office referred Cowboy State Daily to the veto letter Gordon wrote to accompany his line-item vetoes on Senate File 151.

In the letter, Gordon agreed that the rising costs of health care, including prescription drug prices, are a matter of great concern for Wyoming, that is why he’s established the Governor’s Health Task Force to better understand the “cost drivers in Wyoming and to develop meaningful solutions to address the state’s high costs and limited access.”

Gordon said Wyoming’s low patient volumes are part of what’s driving increased costs and that proposed solutions often result in “cost-shifting (to consumers), instead of actually reducing expenses or making the system whole and more affordable.”

Cost-shifting onto consumers is what he feared would happen with SF 151, Gordon wrote, “despite the good work done by all involved to provide local relief.”

Gordon also highlighted a lack of agreement during testimony about the effects of the bill on the cost of health care for Wyoming consumers.

“During the interim, the Insurance commissioner mediated discussions with all parties in hopes of developing legislation that would have positive impacts,” Gordon said. “Unfortunately, after months of collaborative work, these efforts were unsuccessful, and we seem to have arrived back where we started.”

But, Gordon added, he has been concerned about the loss of small-town pharmacies for many years, and remains so.

“Corporate consolidation, vertical integration and increasing prices in the pharmaceutical market have all contributed to increase burdens placed rural pharmacies,” he wrote. “They are under greater stress than perhaps at any time before. As with many providers in the health care system, rural pharmacies are often left to manage operations with insufficient funds, subsidizing certain prescriptions and increasing compliance costs for accountability.”

Too Little Too Late

Gordon tried to take some of the sting out of his line-item vetoes by signing a governor’s directive to the Wyoming Department of Administration and Information to negotiate increased payments for independent pharmacists that participate in the group insurance program for Wyoming state employees and officials.

The increased amount was up to $10 per brand name label, or $12 per generic brand.

That also was too little and also too late, Saul told Cowboy State Daily.

“That was good, but it’s only 5% or 6% of your scrips,” Saul said. “It doesn’t make up for the negative ones that you have that aren’t, you know, Wyoming government insurance.”

Gordon also wrote in his letter that he hoped other health care group plan administrators and insurance providers would follow suit, and he encouraged lawmakers to continue working on the issues to craft a “thoughtful” compromise that would protect the sustainability of Wyoming’s independent rural pharmacies, while controlling costs to consumers.

The latter is something Saul said he is planning to pursue. Now that his business has closed, he has plenty of time to shake things up, and he no longer has to worry about retaliatory audits if he complains.

“In two weeks, there’s a fly-in in Washington, D.C., where the NCPA (National Community Pharmacists Association) has a meeting scheduled with legislators,” he said. “And my wife and I are literally thinking about flying out there. I mean, we’ve closed within the last month, and why have we closed? Well, let me just tell you.”

US committee finds China is subsidizing American fentanyl crisis

It has been reported that the majority of those Americans OD/poisoned by illegal Fentanyl are of “military age”. That age bracket ( M&F ) contains about 60-65 million citizens.  Abt 100,000/yr die from the use/abuse of illegal fentanyl.  In a single year, that is more dying than all the years of war we were in the Vietnam War. That number is abt the same as our soldiers that died in each year of WW-2. Are we in an undeclared war with China?

US committee finds China is subsidizing American fentanyl crisis


FILE PHOTO: A used needle sits on the ground in a park in Lawrence, Massachusetts, U.S., May 30, 2017, where individuals were arrested earlier in the day during raids to break up heroin and fentanyl drug rings in the region, according to law enforcement officials. REUTERS/Brian Snyder/File Photo

WASHINGTON (Reuters) -China is directly subsidizing the production of illicit fentanyl precursors for sale abroad and fueling the U.S. opioid crisis, a U.S. congressional committee said on Tuesday, releasing findings from an investigation it said unveiled Beijing’s incentives for the deadly chemicals.

China continues to provide subsidies in the form of value-added tax rebates to its companies that manufacture fentanyl analogues, precursors and other synthetic narcotics, so long as they sell them outside of China, the House of Representatives’ select committee on China said in a report.

“The PRC (People’s Republic of China) scheduled all fentanyl analogues as controlled substances in 2019, meaning that it currently subsidizes the export of drugs that are illegal under both U.S. and PRC law,” the report said, adding that some of the substances “have no known legal use worldwide.”

The report cited data from the Chinese government’s State Taxation Administration website, which listed certain chemicals for rebates up to 13%. It additionally currently subsidizes two fentanyl precursors used by drug cartels – NPP and ANPP, it said.

According to the Chinese government website, the subsidies remain in place as of April, the report said.

China’s embassy in Washington said China was sincere in drug control cooperation with U.S. authorities and had a special campaign underway to control fentanyl and precursor chemicals and crack down on illegal smuggling, manufacturing, and trafficking activities.

“It is very clear that there is no fentanyl problem in China, and the fentanyl crisis in the United States is not caused by the Chinese side, and blindly blaming China cannot solve the U.S.’ own problem,” embassy spokesperson Liu Pengyu said in an email.

The U.S. State Department did not respond to a request for comment.

Mike Gallagher, the Republican chair of the bipartisan select committee, told a hearing on the issue on Tuesday that China’s incentives suggest Beijing wants more fentanyl entering the U.S.

“It wants the chaos and devastation that has resulted from this epidemic,” Gallagher said.

Fentanyl is a leading cause of drug overdoses in the United States. The U.S. has said that China is the primary source of the precursor chemicals synthesized into fentanyl by drug cartels in Mexico. Mexico’s government also has asked China to do more to control shipments of fentanyl.

China denies the allegation, and says the U.S. government must do more to reduce domestic demand.

The U.S. and China launched a joint counter-narcotics working group in January, following an agreement between U.S. President Joe Biden and Chinese leader Xi Jinping in November to work to curb fentanyl production and export.

U.S. officials have described the initial talks as substantive, but have said much more needs to be done to stem the flow of the chemicals.

The committee also said in its report that it found no evidence of new criminal enforcement actions by Beijing.

Ray Donovan, a former senior Drug Enforcement Administration official, told the hearing that the November agreement had not changed China’s support for the illicit chemical industry’s supply to the Western hemisphere.

“We need to apply more pressure,” Donovan said.


US drug shortages hit all-time high, pharmacists warn: 323 active drug shortages

And what is the FDA’s recommendation?:

Buy more of these medications from CHINA!

US drug shortages hit all-time high, pharmacists warn

Data shows that there are 323 active drug shortages


Drug shortages in the U.S. are at an all-time high, and some of the medications in short supply are life-saving chemotherapy drugs and emergency medications stored in hospitals, pharmacists warn. 

The American Society of Health-System Pharmacists (ASHP) and Utah Drug Information Service reported that there were 323 active drug shortages in the first quarter of the year, marking the most shortages since they have been tracking the data since 2001.

It surpassed the previous record of 320 shortages in 2014, according to the data. 

While ASHP CEO Paul Abramowitz warned that all drug classes are vulnerable to drug shortages, he said that “some of the most worrying shortages involve generic sterile injectable medications, including cancer chemotherapy drugs and emergency medications stored in hospital crash carts and procedural areas.” 

Pharmacy Shelf Drugs

A pharmacy offers a view through a glass pane into the fully automatic medicine store. (Andreas Arnold/picture alliance via Getty Images / Getty Images)

This includes drugs like oxytocin, Rho(D) immune globulin, standard of care chemotherapy, pain and sedation medications, and ADHD medications. 

The “ongoing national shortages of therapies for attention-deficit/hyperactivity disorder also remain a serious challenge for clinicians and patients,” Abramowitz added. 

Short-term shortages are caused by demand outstripping supply, but “the most severe and persistent shortages are driven by economic factors that undermine investment in manufacturing capacity, manufacturing quality, and supply chain reliability,” according to a separate report from the ASHP. 

drug development lab

A worker puts tubes into dry ice at the Pfizer Inc. research and development facility in Cambridge, Massachusetts, on Oct. 26, 2015. (Scott Eisen/Bloomberg via Getty Images / Getty Images)

“These economic challenges are driven by extreme price competition among generic manufacturers,” the ASHP added. 

Abramowitz continued to stress that more work needs to be done at the federal level to fix the root cause of the issue. 

“ASHP will continue to engage with policymakers regularly as we guide efforts to draft and pass new legislation to address drug shortages and continue to strongly advocate on behalf of our members for solutions that work,” he said.

The Department of Health and Human Services (HHS) published a white paper last week recommending ways Congress can assist with the issue.

“With today’s white paper, HHS offers solutions and stands ready to work with Congress to ensure no patient faces the devastating consequences of drug shortages or goes without needed medicines,” it said in a press release.

Jon Stewart On The False Promises of AI | The Daily Show

How scammers have sunk to a new low with an AI obituary scam targeting the grieving

How scammers have sunk to a new low with an AI obituary scam targeting the grieving

Don’t fall for this heartless trick by crooks trying to take advantage of your time of sadness


As if scammers couldn’t sink any lower, there’s a new online scam taking advantage of grieving people. It’s a strange pirate scam that uses AI to scrape data to build fake obituary websites, exploiting the information of somebody who is deceased in an attempt to scam vulnerable victims.

We can only hope that this unfortunate situation doesn’t affect you or anyone you care about. If, unfortunately, you have passed away, there’s little you can do to prevent someone from exploiting your obituary for their own gain. However, these scammers specifically target kind-hearted individuals who are still alive and willing to assist grieving families. It’s essential to remain vigilant and protect yourself and your loved ones from such deceptive practices.



How the fake obituary or “bereavement scam” works

Have you ever been on your social media account and seen someone post an obituary page of someone they have lost? Perhaps you’ve clicked on the links to learn about the person, their impact, how they’ve passed, or to read the information regarding the funeral.

 Maybe you’re even looking to send flowers to the family or a donation in the person’s name. Of course, when someone dies, the last thing you’re probably thinking about is whether or not it could be a scam. But there’s been a rise in bereavement scams by heartless scammers.

Monitoring search trends

Scammers do this by first monitoring Google search trends to determine when people are searching for obituaries after a death.

Creating bogus obituaries

Then, once the scammers find out who has died, they create bogus obituaries with the help of AI that are hosted on legitimate funeral/memorial websites.

SEO optimization

Next, the scammers optimize these pages using SEO tactics so that the scammer’s page ranks first when someone searches for a specific person’s obituary page.

The trap is set

Then, when the prospective victim goes to click on it, though, they’ll be redirected to an e-dating or adult entertainment site, or they’ll be given a CAPTCHA prompt that, unbeknownst to them, will install web push notifications or pop-up ads when clicked.

These may give fake virus warnings but link to legitimate landing pages for subscription-based antivirus software programs. Worrying that you might accidentally download a virus, innocent victims instead walk right into a scam.

The scammers profit in two ways

After this, two things can happen:

  • Scammers monetize this via affiliate reward programs from software downloads people are tricked into thinking they need.
  • Scammers get revenue from adverts on the page that pay per impression.

So, while they may not explicitly target you in the same fashion as other scams, they’re still quite creative. Although Secureworks Counter Threat Unit emphasizes that this scam is not currently infecting devices with malware, it is possible that this scam could evolve in that direction in the near future.


How to protect yourself from falling for an obituary scam

To protect yourself from one of these scams, there are a few questions to ask yourself if you see an obituary page:

Do you have a connection to the person who has passed away? If you’re not connected in any way to the person you see the obituary page for, don’t click on it. And, if you do know the person, make sure you click on the original link that was shared on social media from the contact you know well; don’t search it in Google, as the first option that comes up could be a fake one.

Know the fake websites. Some fake obituary websites include Nextdoorfuneralhomes.com, Memorialinfoblog.com, Obituaryway.com, and Funeralinfotime.com. But keep in mind that some scammers are using common sites, too.

Check if the person has actually passed away. This may seem obvious, but some of these scammers are writing obituaries for people who have not actually passed away!

Look out for suspicious pages. Key signs of a fake obituary include overly descriptive language and an impersonal tone. Many scammers rely on AI to write these obituaries as quickly as they can and don’t usually take the time to review them to make them sound more human. After all, they are in a rush to snag you shortly after the person has died.



Kurt’s key takeaways

Many scammers prey on emotionally vulnerable people to get their way. Though this obituary scam is next level, it’s not much different than someone taking advantage of someone during a phone scam, where the victim is rushed to send over money or provide information. So, always keep your wits about you if you’re ever not sure. Before clicking on a link, opening a file, or answering that phone call, take a minute.