May is national mental health month

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

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. St. Jude Children’s Research Hospital – deals with kids dealing with cancer and/or life threatening health issues Shriners Hospital – deals with kids, born with “broken bodies” and birth defects 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 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



Optum ditching facilities and staff to protect bottom line?

Optum is a PBM, the FDA and many state legislatures are looking into how the PBM industry functions financially and Pres Biden is claiming that he is going to lower Rx prices. Is this how Optum is trying to get a head start on any impact that all of these things could do to protect their bottom line? Closing a 93,000 sq ft facility – that is about 1.5 times the size of your average Walmart store.  The second article states that RN case managers are being laid off. Are these part of the process dealing with prior authorizations?m Does this mean that more PAs will be denied and/or take longer to get one approved?

Optum laying off 129, closing Ohio facility

Optum is closing a Change Healthcare facility in Toledo, Ohio, resulting in the termination of 129 employees located in Ohio or working remotely.

The layoffs will occur in three waves from July 15 to Sept. 6, according to regulatory documents filed with the state on May 16. The 93,000-square-foot facility is located at 100 North Byrne Road in Toledo.

In April, former employees with Optum and its subsidiaries took to social media regarding a reduction in force they say occurred across the company. Optum declined to provide more information about the layoffs at the time, and it is unclear if they are connected to the Toledo layoffs.

Optum also laid off an unknown number of employees in August. Affected facilities included the Everett (Wash.) Clinic and the Polyclinic in Seattle; Morgantown, W.Va.-based MedExpress Urgent Care; and San Antonio-based WellMed.

Here is a earlier article concerning these layoffs

Optum enacts layoffs, workers say

Former employees with UnitedHealth Group’s Optum and its subsidiaries took to social media beginning April 18 regarding a reduction in force they say occurred across the company.

Optum declined to provide more information April 19. Becker’s has not confirmed an exact number or range of employees who may have been terminated or when layoffs would be effective.

Across LinkedIn, former employees with Optum and affiliated providers have detailed layoffs enacted at their organizations. A range of roles appear to have been affected, from RN case managers to senior director and management positions.

In 2023, many large insurers conducted large workforce reductions due to financial or operational challenges in certain segments, along with restructuring strategies. 

Optum also laid off an unknown number of employees in August. Affected facilities included the Everett (Wash.) Clinic and the Polyclinic in Seattle; Morgantown, W.Va.-based MedExpress Urgent Care; and San Antonio-based WellMed.

UnitedHealth is still recovering from the cyberattack on Change Healthcare in February — the company had reinstated 80% of the functionality for its claims, payment and pharmacy services as of April 16.

UnitedHealth Group posted a $1.4 billion net loss in the first quarter of 2024, primarily due to the sale of its Brazil operations, along with the cyberattack. Despite the losses, the company beat investor expectations.

How we could cut the illegal opioid drug poisoning

I know that it would be crazy to expect our Federal Gov to address this crisis with a business mindset.  Go after the crisis like Walmart or Amazon gets rid of competitors, sell stuff FOR LESS!

Addiction is never going to go away. It is claimed that alcohol causes 100,000/yr deaths, but only about 1% of the deaths are from alcohol toxicity BAL >0.4. One percent is 1,000/yr OD from alcohol. This is probably because alcoholic know the “strength” of their drug of choice and know what their limit is.

The Feds seize how many tons of illegal Fentanyl?  Hire a pharma to test, to make sure that it is only Fentanyl. Take the seized Fentanyl and create standardized- unique tablets- with several strengths- and sell them at the Feds net cost. Undercut the street merchants and the Mex cartels.  Maybe put the bottles of these opioids in vending machines in highly visible locations to help prevent vandalism. This way, chronic pain pts could get adequate therapy and addicts can get their “fix” and hopefully fewer would OD/poisoned.

Was George Orwell a futurist and we are seeing it now 40 yrs later?

Protesters gather to speak out against pharmacy benefit managers

ST. LOUIS – Dozens of protestors are making sure they were seen and heard Friday morning outside Express Scripts in north St. Louis County. 

They say pharmacy benefit managers, like Express Scripts, are manipulating drug prices, steering patients to their own mail and retail pharmacies and creating obstacles for patient access. Park Hills, Mo., resident Loretta Boesing organized the event.

“The fight will continue until we get justice, until we get protection as patients, until there’s justice for every pharmacy that’s closed due to their monopolistic practices,” Boesing said.

FOX 2 first met Boesing in 2018 after her family was forced by insurance to switch to a mail-order pharmacy. Her son’s medication was poorly packaged and damaged in the heat. The dose sent him into liver rejection, and he was lucky to survive. The experience spurred her activism.

“We need more protection. We need the FTC and our legislators to do more,” she said.

Local independent pharmacy owner Jerry Callhan took part in the protest. Since 2019, we’ve chronicled his growing criticism of pharmacy benefit managers, the impact on his patients and his business.

“People need to understand how they’re getting shafted by the PBM industry” Callahan said.

Friday’s protest had national reach. Himanshu Patel owns an independent pharmacy in Chattanooga, Tenn.

“It’s about life and death for me. It’s either come here and fight or stop working as a pharmacist and do something else,” Patel said.

Doug Hoey is CEO of the National Community Pharmacists Association.

“There’s legislation that’s been passed in the house, but we need the senate to take it up. And there’s also legislation that would help with Medicare, which is a third of the business of the average pharmacy,” he said.

Missouri Democrat Lucas Kunce, who attended the protest, says he’d fight for it if elected to the U.S. Senate.

“We need to use the Federal Trade Commission, the Department of Justice, we need to use all the tools at our disposal to just enforce the monopoly laws we have, break these guys up and protect us from their predatory actions,” Kunce said.

Express Scripts gave FOX 2 the following statement:

“The health of our customers is at the center of all we do. We work relentlessly to ensure our customers can access their medications at the lowest possible cost and in the way that is most convenient for them. Our flexible pharmacy networks include pharmacies of all scales and sizes, including large chains, regional and independent pharmacies, as well as home delivery options.”

Express Scripts

“We hadn’t had something that brought us all together and united us against these corporations. That is my goal here today. This is just the start. This is only the beginning,” Boesing said.

GA Governor Kemp veto bill to prevent PBM from paying indy pharmacies less than chains get paid

On ‘This Week in Pharmacy’ we’re blowing the doors off the story in Georgia how Owners of independent pharmacies are criticizing Governor Brian Kemp’s decision this week to veto legislation aimed at rectifying a situation that has left them at a competitive disadvantage with pharmacy chains. We’re also talking about Identification Technolgies driven by A.I., by Alitheon, with a huge impact to the world of counterfeit medications. Independent Pharmacy Owners in Georgia take another blow to the face as their businesses and PublicHealth Services to their communities are threatened by the latest decisions on Senate Bill 198. Owners of independent pharmacies in Georgia are criticizing Gov. Office of Governor Brian P. Kemp ’s decision this week to veto legislation aimed at rectifying a situation that has left them at a competitive disadvantage with pharmacy chains. Senate Bill 198, which the state House and Senate passed with only one “no” vote, would have required the State Health Benefit Plan (SHBP) covering teachers and state employees to reimburse independent pharmacies filling prescriptions at rates no less than the average reimbursement provided to chain pharmacies. Full article here: This is State Representative Buddy Carter’s home state and as a pharmacy owner, I am sure he’s in disagreement with this decision which will exacerbate the problems our Georgia State Independent pharmacies are facing, causing many to face financial problems and some pharmacies will be forced to close. To add to this story, PPN was informed that the President of the Georgia Pharmacy Association Mr. Joe Ed Holt was fired from PruittHealth for publicly disagreeing with the decisions of Georgia State Governor Kemp vetoing SB198 which makes reimbursement for Independent Community Pharmacies unfair compared to mail order and chains?? “Fraudulent and unidentified goods infiltrate nearly every industry, damaging businesses, economies and livelihoods, as well as risking public health and safety,” said Roei Ganzarski, CEO of Alitheon. “TIME’s recognition of FeaturePrint as a leading invention puts this growing problem in the spotlight, where it should be.” Alitheon’s FeaturePrint enables you to trace and authenticate any individual items wherever they go and along the way, including medications. On the assembly line or in the marketplace, track and trace the one in the millions and know with certainty, that they are not being swapped, changed, or faked along the way.

Pharmacies sharing medical records without warrants

A shocking revelation by Congress is calling into question Americans’ right to privacy about their health, and if private medical data can be used criminally against you. In a letter to the Department of Health and Human Services, lawmakers share their concerns over how the nation’s largest pharmacy chains handle requests for records from law enforcement, which do not require a warrant. Healthcare attorney Harry Nelson breaks down what is happening. #Health #Pharmacies #medicalrecords “NewsNation Now” is a no fluff, no filler newscast hosted by Nichole Berlie and Connell McShane featuring up-to-the-minute news drawing from a network of journalists across the U.S. Weekdays starting at 1p/12C. NewsNation is your source for fact-based, unbiased news for all America. More from NewsNation: Get our app: Find us on cable: How to watch on TV or streaming:

Lobbyists for PBMs come to a legislature bringing LIES and $$$ for re-election campaign funding

Pharmacy benefit managers or PBMs for short, now wield nearly limitless power and influence over the prescription drug market owning at least 85% of pharmaceutical industry. Their tight grip on the market has allowed them to engage in unfair pricing practices with very little oversight. They can raise the price you and your insurance company pay for medications, and instead of passing that revenue along to pharmacies, they keep it for themselves. Without having to answer to anyone, they rake in the cash off consumers backs and hurt patients in the process.

Which leaves the question, what is being done about it and how are they not being regulated? Well, let’s dive in …shall we.

A bill was presented at the state level during last session to demand PBM reform, unfortunately it didn’t even get called to vote.

“Why it didn’t get voted upon is something that will anger me forever, because it has everything to do with politics and money and had nothing to do with the right thing,” said Dan Strause former CEO of Hometown Pharmacy. 

Wisconsin Representative Micheal Schraa, shares some insight.

“The general public has no clue. I spoke at a Republican Lincoln day dinner about three weeks ago. And I said how many people in this room, and there were about 140 people, how many in this room know what a PBM is, pharmacy benefit manager, six hands went up,” said Schraa. 

Yet the negative Impact PBMs have on the nation’s healthcare system is growing daily. As more and more small pharmacies are getting smothered out of the equation.

Schraa said his drive to push PBM Reform legislation started about 10 years go when his pharmacist Ken brought it to his attention.

“I walked in one day and Ken just said, you got to sit down with me, and I got to tell you what’s going on. Were getting killed by these things, by these PBMs, and I’m like what’s a PBM, I never heard of it before,” said Schraa. 

Micheal said he started doing his own research and asking questions, the more he learned the more eye opening it was to him. That something needed to be done.

“There we a lot of powerful statements and a powerful testimony from people that had personal experiences with how the PBMs have negatively affected them. So, it’s just been my mission. I knew I would be coming again this session with another bill. Senator Felzkowski and I worked on it and it was really frustrating at the end, not having it go anywhere.

Bill 737 had 104 co-sponsors on it out of 132 legislators. Schraa personally went to every single democrat and republican office in efforts to get as much bipartisan support on the bill as possible.  But it never even got called to the floor to be voted upon during the last legislative session. There were 13 separate asks in the bill and there were even efforts made to amend a single one of these asks into a separate bill, pertaining to hospitals, that would demand some transparency from PBMs regarding formularies. (Called MAC Pricing Language which is a spread showing the average cost of a drug across all companies that manufacture that drug.) In hopes that it would be the most beneficial piece to independent pharmacies.

“So, we had this amendment and we added it to another bill that the hospitals really needed. We felt this was a bill that couldn’t be killed and wasn’t going to have an issue in the Senate,” said Schraa. 

“The Mac language was kind of watered down a little bit, but we still got a chunk of it in there. I thought this is great. The governor’s office was in they didn’t like a little bit of wording so we changed it to appease them so they would sign the bill, or sign the bill that this amendment went to, and we passed it. And it went over the senate and died,” said Schraa. 

There are many speculations as to why the PBM reform bill, has been avoided.

“The ugly part of politics is that campaigns cost a lot of money to run and not everybody can self-finance especially in the assembly or the senate,” said Schraa. 

However, Schraa said there are still those willing to fight for the people and what’s right.

“That’s where the heart of this issue comes in. There’s 30-some other states that have passed pretty significant PBM reform. The decision makers in those states have made a decision, we’re going to stand up for the people,” said Schraa.

Schraa has a plan for the next legislative session to break down this complex bill and get it passed.

“It’s a complicated issue,” said Schraa. Unless you’re a pharmacist or someone who works with this everyday it can be really hard to focus on the several different things this bill highlights. Schraa plans to break it down to have a legislator for each section.

“That way I think the health plans and PBMs that are against this, its going to be a lot harder for them to come in and trash 12 or 13 different legislators. They were going around lobbying in each office saying, you know Schraa’s PBM bill is going to raise prescription drug costs, out right lying,” said Schraa. 

Schraa said he understand lobbyists and their job is to protect their clients.

“There’s so much money in this game for them and they’re so powerful and the lobbying core is so well paid,” said Schraa.

Schraa said it’s frustrating because he sees the net effect that PBMs are having on so many people including his own family, who have fallen victim to adverse medical reactions due to wrongful practices. Schraa said, he and fellow supporters will continue to bang their fists on the desk until PBM reform is accomplished.

“The education process is huge, and I think this patient protector will be a game changer. It’s going to be super hard for them to continue to shovel this underneath the table and try to hide it. When you have so many different avenues bringing the light out and exposing, you know light is the best disinfected and that’s starting to happen,” said Schraa.

That’s why was created, if you or a loved one are being affected, share your stories on the online portal so they can be heard by legislators and a difference can be made. 

A Philadelphia pharmacy’s closure after 26 years highlights the industry’s growing challenges

A Philadelphia pharmacy’s closure after 26 years highlights the industry’s growing challenges

Last Monday, Friendly Pharmacy filled 318 prescriptions. For about 100 of them, insurance companies paid the pharmacy less than $3.

In 22 instances that day, the reimbursement was less than the cost of the medication. And that’s just among the prescriptions that were actually filled. Managing pharmacist Brad Tabaac said he has to turn away some patients because their prescriptions will cause too much of a loss for his business.

One recent patient, for instance, came in hoping to transfer his inhaler prescription to Friendly after his local Rite Aid closed. Filling the medication would have cost Friendly $22 more than the insurance reimbursement.

“I just can’t afford to serve him,” Tabaac said.

And now he can no longer afford to serve anyone.

Tabaac plans to close his doors on May 31 after 26 years in business. As a second-generation pharmacist, he said, he’s been working in drug stores since he was 11 years old. Making money on medicine wasn’t a question back then, but now it’s a string of “exhausting” calculations on a daily basis.

“Years ago, you would just fill prescriptions, and you would concentrate on patient care,” Tabaac said. “Now you have to look at each and every prescription you fill and say, ‘Am I losing money?’”

Why pharmacy benefit managers are challenging small pharmacies

Independent pharmacies like Friendly, as well as some chains, have been pinched by pricing and fees set by pharmacy benefit managers — the companies that handle prescription drug plans for health insurance.

The three biggest pharmacy benefit managers are CVS Health, Optum Rx and Express Scripts. They control nearly 90% of the market, according to the National Community Pharmacists Association (NCPA), and some of their parent companies also own pharmacies. In other words, NCPA has said, “what community pharmacies charge patients and are reimbursed is often determined by a competitor.”

This challenge has caused more than 80 community pharmacies in Pennsylvania to close just in 2024, said Rob Frankil, executive director of the Philadelphia Association of Retail Druggists (PARD). Contracts with pharmacy benefit managers are “take it or leave it,” he said, giving individual business owners little to no room for negotiating reimbursement rates that will allow them to stay in business.

PARD has been lobbying lawmakers for changes.

The Federal Trade Commission is conducting an inquiry into the system. Chair Lina M. Khan said at a White House Roundtable in March that complaints to the commission suggest pharmacy benefit managers “hike the price of drugs, deprive patients of access to certain medicines, and drive community pharmacies out of business.”

As pharmacy benefit managers “have consolidated and vertically integrated, we hear of a system where corporate red tape and bureaucracy obstruct patients from getting their medications, sometimes with devastating results,” Khan said.

Khan noted that the pharmacy benefit managers haven’t fully complied with FTC orders seeking documents and data.

“We are undertaking this work with enormous urgency and focus. And if we find evidence of illegal practices, we will not hesitate to act,” Khan said.

Tabaac acknowledges that effort but said it’s coming too late for his business.

“Pharmacists knew they were going to lose money on branded drugs,” he said. “But they were signing these contracts because they were thinking, ‘What else am I going to do?’”

Other costs rising

While Tabaac can’t control the revenue he brings in from prescriptions, despite having plenty of customers, he also can’t control certain costs that have risen in recent years. One of them is business insurance, he said, which has become more expensive in part due to his pharmacy’s location in the Kensington neighborhood. Friendly was dropped by its business insurer in recent years because of incidences of vandalism in the community, he said, and had to find a new policy.

“The insurance companies do not want to insure us,” Tabaac said. “We’re too much of a risk.”

Once Friendly closes, the closest chain pharmacy is a Rite Aid about three-quarters of a mile away. A few other independents remain open closer to Friendly’s location, according to city records, but pharmacy density here is lower than in other sections of the city.

Not long ago, Tabaac absorbed the patients from another independent pharmacy nearby that closed because of finances.

Tabaac is concerned about the patients who have accessed prescriptions through Friendly’s delivery services or relationships with doctors who do house calls, as well as those who don’t drive and will have to take public transit to a new location.

“Will they find an advocate? Some of them will,” he said. “I fear that many of them won’t.”

FDA issues ‘most serious type of recall’ for insulin pump-related iOS app

FDA issues ‘most serious type of recall’ for insulin pump-related iOS app

The U.S. Food and Drug Administration has issued a Class I “most serious type of recall” for an iOS app used in conjunction with an insulin pump.

The “correction” as referred to by the FDA on Wednesday, rather than a product removal, relates to the t:connect Mobile App iOS v2.7. It was confirmed by Tandem Diabetes Care the following day, which stated that Android app users are not included in the recall.

“The t:connect mobile app works with the t:slim X2 insulin pump with Control-IQ technology,” the FDA states. The pump delivers insulin under the skin at set and variable rates for the management of diabetes. 

The app recall is due to a software issue that may cause the app to crash and be automatically relaunched which “may result in pump battery drain and may lead to the pump shutting down sooner than typically expected.”

The FDA says pump shutdown “could lead to an under-delivery of insulin and may result in hyperglycemia or even diabetic ketoacidosis, which can be a life-threatening condition due to high blood sugars and lack of insulin,” and encourages those with diabetes who use insulin pumps to carry backup supplies in case of pump failure.

“The correction highlighted in the recall notice was addressed in the t:connect app update for the Apple iOS platform (v2.7.1) released on March 18th,” Tandem Diabetes Care said in a press release. “Affected customers were notified by Tandem on March 26th, and more than 98% of affected customers had already updated their devices as of April 15th. We continue to make every effort to contact everyone who has not yet updated their iOS app to the new version.”

Tandem Diabetes Care gives detailed instructions to customers who wish to check their mobile app versions here. 

“Ensuring the safety of our patients is our top priority, and we take any safety concerns with our products very seriously,” Tandem Diabetes Care said in its release. “No deaths have been reported, and we will continue monitoring the new version of the t:connect app released in March to ensure the concerns described in the recent recall notice from the FDA have been addressed.” 

bye-bye so sad

Be careful what you post in titles. I  have a post concerning a chronic pain pt Robert Charles Foster who had lost his pain meds and ended up getting cops to end his pain FOR GOOD.

Apparently, there was a couple of words in the title that did not meet FB’s “community standards” and they deleted them.

They seem to have a problem with intractable chronic pain pts resolving their untreated torturous level of pain via some sort of self-inflicted means.

The hyperlink above points to the one post on FB, they have not found yet.  See how far they go to see if the community standards are met!