CVS Caremark continues to flout West Virginia law

Maybe this explains why the CVS Health net profits are substantially increasing each year when other pharmacies are having trouble just paying their bills. Rite Aid just declared their last bankruptcy and closing their last 1000 stores. Walgreen is selling the company to some financial group.

The West Virginia Office of the Insurance Commissioner (OIC) issued a $1.4 million fine to CVS Caremark based on 2,871 violations of several provisions of the 2021 Pharmacy Audit Integrity Act. The OIC said CVS Caremark improperly applied the definition of “rebate” when withholding rebate payments and fees from the health plan, recouped excessive funds from pharmacy claims relative to the financial harm associated with the dispensed products, and exceeded the maximum number of prescriptions covered in a pharmacy audit.

The company also delivered contracts and communications to providers that cited fees associated with the cost of pharmacy audits in excess of those allowed by law and unreasonably designated 65 covered prescription medications as specialty drugs.

The commissioner ordered CVS Caremark to file a plan to address the violations within 30 days and is allowing 90 days to implement it. In the meantime, CVS Caremark requested a stay of the penalty order through the state’s Supreme Court of Appeals. The OIC previously fined CVS Caremark for reimbursing pharmacies below the required commercial market benchmark of NADAC plus the state Medicaid program’s professional dispensing fee.

Does Sec Kennedy have a clue of the 100+million chronic pain pts will never be able to participate in MAHA

Is PAM BONDI/DOJ/DEA AGENDA diametrical opposed to Sec Kennedy’s MAHA (Make American Healthy Again) agenda?  Some 25%-30% of our population has had their QOL continuing deterioration over the last decade. How can that population have any chance of getting healthy again and optimized their QOL, if the intensity of their chronic pain has been increasing because of DOJ/DEA has been constantly intimidating practitioners to prescribe fewer and fewer pain meds along with making the pharmas production quotas >50% less over the last decade. 

Sec  Kennedy is in charge of MAHA (Make America Healthy Again). My money is on that this woman who posted the text below, he doesn’t have a clue about this woman or probably millions of chronic pain pts that are suffering/dying out of sight – out of mind. She is also one of millions that will never be able to attempt to GET HEALTHY AGAIN. All wars have their COLLATERAL DAMAGE, How many tens of millions of chronic pain pts are/have been collateral damage of the war on drugs that has turned into pretty much a COVERT GENOCIDE?

This is suppose to be RFK,Jr’s secretary’s email:  OSA11y@hhs.gov

Robert F. Kennedy Jr. arrives to testify before the Senate Finance Committee during a confirmation hearing on his nomination to be Secretary of Health and Human Services on Jan. 29, 2025, in Washington, DC.

I want to thank you for everything you and Dr Ibsen do for the pain community. You are an amazing human being. A couple of weeks ago I couldn’t take it anymore. I felt like the pain was getting worse and I got sicker. I became homeless and that was the last straw for me. I decided to end my life. I don and cannot do this anymore and if it wasn’t for the stupid cleaning lady at the hotel I would have succeeded I spend time in the ICU and then in a horrible mental ward, then back on the street. My dignity was taken from me. I now have a roommate and thought I would get back on track. But my health won’t hear of it. I have on top of AA cellulitis in both of my lower extremities, kidney stones and a couple of days ago a Merda diagnosis. The spores are in my body. I was send home with four antibiotics that are killing my body as well as Ibuprofen and Tylenol for the stones. I can’t walk far anymore and have given up I wrote a letter for you and Mark should something happen to me. Please, get it to a newspaper. I know I am asking much but I don’t have anyone who would do that for me. Please continue to support those patients and Mark, keep fighting. I love you both, thank you from the bottom of my heart.

OpenEvidence says its AI model has scored a perfect 100% on the United States Medical Licensing Examination (USMLE)

OpenEvidence AI scores 100% on USMLE as company launches free explanation model for medical students

https://www.fiercehealthcare.com/ai-and-machine-learning/openevidence-ai-scores-100-usmle-company-offers-free-explanation-model

Artificial intelligence startup OpenEvidence says its AI model has scored a perfect 100% on the United States Medical Licensing Examination (USMLE), raising the bar on the proficiency of AI models to interpret medical information.

The company spent the last six months evolving the core AI models and other technologies that power OpenEvidence and training a more advanced reasoning model, Daniel Nadler, Ph.D., founder of OpenEvidence, told Fierce Healthcare. The company’s AI models had scored a 90% on the USMLE two years ago.

“The models can actually reason step by step and do what I would call a second or third derivative reasoning, which means not just taking the fact that comes in before you, but taking the factors in before you, figuring out what those imply, and then reasoning through the implications,” he said, noting that OpenEvidence’s AI models have achieved “super high-grade medical reasoning.”

The USMLE is a three-step exam that is required for medical licensing in the U.S., with each step evaluating different aspects of whether a doctor has the knowledge and skills to provide safe and effective medical care.

Nadler asserts that what is key to this development is that OpenEvidence is offering a new AI system that not only accurately answers each question on the USMLE but also teaches the reasoning behind each answer.

The company is rolling out an explanation model that demonstrates the reasoning behind the correct answers as a free medical education resource. The models provide accurate references using gold-standard sources of medical knowledge such as The New England Journal of Medicine (NEJM) and the Journal of the American Medical Association (JAMA), the company said.

Nadler said the new AI explanation models and other tools will help “democratize” access to quality medical education resources and support.

OpenEvidence developed an AI-powered medical search engine and generative AI chatbot exclusively for doctors that summarizes and simplifies evidence-based medical information. Founded in 2022 by Nadler, the company touts that it’s the most widely used medical search engine among U.S. clinicians, claiming more than 40% of physicians in the U.S. use its platform.

The company offers its chatbot to physicians for free. It is actively used across more than 10,000 hospitals and medical centers nationwide, and it continues to grow by more than 65,000 new verified U.S. clinician registrations each month, the company claims.

OpenEvidence has formed strategic content partnerships with the American Medical Association, the NEJM, the JAMA and all 11 JAMA specialty journals including JAMA Oncology and JAMA Neurology. The startup has raised more than $300 million since its founding, including a $210 million series B raise last month, at a $3.5 billion valuation.

The new AI explanation model will be available for free for physicians with a national provider identifier and professionals with a medical education number, Nadler said.

These tools were built “with a focus on education, creating vignette and case-based learning customizable by training level with reasoning and explanations grounded in the current medical literature,” according to the company. It demonstrates OpenEvidence’s commitment and continued effort to improve physician knowledge at all levels of medical education.

“There’s an enormous amount of inequality in medical education in the United States and in preparation for medical school exams,” Nadler noted, as the cost of medical school education continues to rise.

With the launch of the free medical education tools, Nadler says he is coming full circle as he worked at test prep company Kaplan while he was in school.

“Those who could pay for very expensive high-grade test prep tended to do better on the test because they had people like me walking them through the explanations of the answer,” he said. “I’ve seen the direct value of seeing an explanation for an answer. An explanation of why an answer is the correct answer is so critical in helping someone prepare and study for a test and to learn the body of knowledge. The point is not just to pass the test. The point is to learn it.”

With advancements in AI and its increasing use in healthcare, AI companies and researchers have been evaluating the performance of AI models on medical exams to test their proficiency with medical knowledge and interpretation. AI’s performance on medical exams has significantly improved over time. In late 2022, a study found that OpenAI’s ChatGPT was able to score at or close to the 60% passing grade needed for the USMLE. Later that year, researchers evaluated ChatGPT-4 on USMLE Step 1-style questions, and it answered 86% of the 1,300 questions accurately.

OpenAI’s latest model, ChatGPT-5, scored a 97%, according to OpenEvidence’s evaluation, Nadler said.

Back in April, biomedical informatics researchers at the University of Buffalo said a clinical AI tool they developed demonstrated improved accuracy on all three parts of the USMLE. The tool, called Semantic Clinical Artificial Intelligence (SCAI), scored as high as 95.1% on Step 3 of the USMLE, notably outperforming GPT-4 Omni, which scored 90.5% on the same test, according to a paper published in JAMA Network Open.

However, testing AI on medical exams is just one benchmark. Many industry experts say argue that many of these evaluations focus heavily on question-answer tests and not enough on evaluating real-world medical tasks.

Microsoft’s AI team recently released a paper that evaluated how well AI diagnosed medically complex cases from the NEJM as compared to doctors. That paper looked at Microsoft’s AI-enabled diagnostic system, called the Microsoft AI Diagnostic Orchestrator (MAI-DxO), and found it can accurately diagnose up to 85% of complex medical cases, a rate more than four times higher than a group of experienced physicians.

Nadler agrees that a USMLE score is not the best way to evaluate OpenEvidence in a clinical context.

“I think this is just strictly applicable to helping future doctors really prepare for and understand the answers to the USMLE,” he said. “What we’re actually much more proud of is the ability to reason out and explain step by step why something is the right answer. I think there’s a lot of value there. This, to me, is much closer to medical intelligence.”

Health tech and AI companies are racing to expand their footprints in healthcare and to be the go-to tools for doctors in medical decision support. Just last week, Doximity bought Pathway Medical for $63 million to bulk up its healthcare AI capabilities as it looks to offer more free AI tools to doctors. Pathway claims it has one of the largest structured data sets in medicine, “spanning nearly every guideline, drug and landmark trial across all major specialties.”

Earlier this year, Pathway said its AI models top the publicly reported leaderboard on the USMLE, achieving a 96 % accuracy rate. At that time, Pathway said it outperformed other medical‑AI systems such as GPT‑4, Med‑Gemini, OpenEvidence and Hippocratic AI.

Now, there’s a legal feud as OpenEvidence sued Pathway for trade secret theft earlier this year alleging the company “invaded the OpenEvidence AI platform repeatedly and executed dozens of ‘prompt injection’ attacks.”

OpenEvidence filed a similar suit against Doximity in June.

This is going to be an evolving story of a Disabled Female chronic pain pt

Pt’s statements in RED: My words are in Green

Remember she is doing speech to text

This disabled female pt reached out to me Aug 4th and her doc had just abruptly cut her oral opioids she had been taking for ~ 10yr from 90 MME/day to 30 MME/day and put a Buprenorphine patch on her the next day. This is just starting to evolve but I am going to leave this post at the top of the first page and update as things happen – STAY TUNE

This is Aug 5th:

My. Primary. Just upped my blood. Pressure meds he said. It could ending up having. A stroke    Could it be the patch. Causing my blood. Pressure. Going. Up. So. High

Is your doctor just an employee of a large hospital system. I would like to put a spot light on his employer – let me know

 

 

 

A day or two after she put the buprenorphine patch on she was scheduled to have a treadmill cardiac stress test. Before the test, they took her blood pressure and it was 240/120 – what the American heart Association claims is a hypertensive crisis level. This test was done in part of a hospital system. Of course the stress test was cancelled, and the staff just SENT HER HOME. Before she had the patch on, her blood pressure was more normalish. Here is the American Heart Association on its definition of blood pressure. You may have to click on the graphic TWICE to make it enlarge and more readable

 

The FDA & state boards of pharmacy have no cojones nor a backbone

It is the FEDERAL LAW, if a patented Rx med is unavailable or in short supply, then compounding pharmacy can compound the Rx med as long as the med is unavailable or there is a shortage. The shortage of the GLP-1 injectables have been readily available for months.

From what I have read, the FDA has sent these compounding pharmacies letter to cease and desist. Both Nova & Lilly has sued these companies and if any state Board of Pharmacy has taken any action – revoking their pharmacy license – I have not seen any of the media covering it.

What I have read is these compounding pharmacies at not using the exact same medication/ingredient that is being put in the commercial product. Also, Zepbound is the only GLP-1 medication that works on both GLP-1 receptor and the GIP receptor and “they” are working on a medication that will work on the last and third receptor. Lilly also sells Mounjaro which is the same as Zepbound, but specifically FDA approved for treating Diabetes type-2

I have also read that these compounded pharmacy’s products share some serious side effects with the commercial products, but more frequently than the commercial products.

Lilly has for some time been offering their Zepbound in vials and all strengths via their arrangement with a mail order pharmacy and all strengths are <$500 for 4 vials. That is about HALF of the price of the auto-injector.  Here is the link to their mail order service  https://www.lilly.com/lillydirect/medicines/zepbound

Zepbound (tirzepatide) injection Single-dose Vial 15 mg/0.5 mL

 

Despite FDA ruling, compounded GLP-1s are still giving Novo and Lilly headaches on the market

https://www.pharmavoice.com/news/fda-ruling-compounded-glp-1s-novo-nordisk-eli-elilly/757841/

Copycat weight loss drugs were supposed to be pulled from the market, but pharmacies have found a loophole.

When the FDA took Novo Nordisk and Eli Lilly’s GLP-1 medications off of the drug shortage list, the move should have been a death knell for copycat compounded versions. But then something unexpected took place. 

Compounding pharmacies found a loophole and continued making off-brand versions of the lucrative weight loss drugs. Months later, compounded GLP-1s are still for sale on direct-to-patient platforms like Hims & Hers

Compounded drugs, which are not FDA approved, are allowed on the market when the brand-name medications are in shortage or when patients need personalized versions. When Novo and Lilly’s drugs were in short supply last year, compounded GLP-1s were also sold at a significantly lower cost for those paying out of pocket. 

But once the shortage was over, the FDA gave compounding pharmacies a grace period before it planned to crack down. Now, with the grace period long over, compounding pharmacies still operate by making their GLP-1s “personalized,” with slight changes to formulas. It’s a strategy some experts have described as a regulatory failure

The compound drug issue has hit Novo particularly hard.

Earnings impact

During its second-quarter earnings call with analysts, Novo executives noted that compounded GLP-1s are impacting uptake for Wegovy prescriptions and the stunting the overall growth of the branded obesity market this year.

“Multiple entities continue to market and sell compounded GLP-1s under the false guise of personalization, and it is estimated … around 1 million patients are on compounded GLP-1s in the U.S.,” said David Moore, president of Novo Nordisk and executive vice president of U.S. operations. 

At the same time, Novo has been grappling with tougher competition from Lilly, whose share of the obesity market rose to 57% as of the second quarter.

The compounding market is also becoming more complex. Several telehealth platforms that offer compounded GLP-1s have partnered with Lilly or Novo to offer their branded weight loss drugs. For example, health and fitness platform Noom partnered with Lilly’s direct-to-patient platform LillyDirect earlier this year to sell vials of Zepbound. However, Noom also launched low doses of compounded semaglutide this month starting at $119 per month — about a quarter of the cost for the branded drug’s starting dose.

The microdoses may reduce the impact of side effects from semaglutide use, which have caused many patients to abandon the treatments

“We set out to virtually eliminate side effects for the vast majority, so that more than 70% of people would encounter no side effects,” Dr. Jeffrey Egler, chief medical officer at Noom, said in a statement. “In both my clinical experience and evidence in published studies, it is clear that many people discontinue GLP-1 treatment because of side effects.”

Lilly said in June it would only partner with telehealth platforms that agree not to sell compounded GLP-1s.

Novo’s DTC channel offers vials of Ozempic for about half the list price of its injectable pens. But compounded versions are taking too much share from this out-of-pocket option, diminishing Novo’s quarterly results and financial outlook, executives said this month.

“As unsafe and unlawful mass compounding continues, the Wegovy penetration within the cash channel has been lower than expected,” Moore said on the earnings call.

New lawsuits

Lilly and Novo maintain that personalized compounded GLP-1s are running afoul of the law, and both have launched new lawsuits in an attempt to prohibit pharmacies from selling the products. The companies also argue that compounded GLP-1s put patients at risk.

Novo filed 14 new lawsuits this month against medical spas, telehealth platforms and compounding pharmacies, alleging the “unapproved knockoffs” of Wegovy are made with illegal APIs and are not safe. The suits also allege companies are violating the law by influencing doctors to steer patients toward the compounded versions.

“This is a priority for our company. This is a priority to protect patient safety. This is a priority to ensure that the laws are followed,” Moore said of the lawsuits during the earnings call. 

Moving forward, Moore also said “there is nothing categorically that is off the table” with respect to the litigation. He also said Novo has increased dialogue with the FDA to put more pressure on companies that are “misleading patients” with the compounded GLP-1s.

The FDA recently updated its warning about unapproved, compounded GLP-1s, calling them “risky.”

FDA Approves First-in-Class Drug for Fibromyalgia

Personally, I always thought of Fexeril as a fairly “crappy” med.  One time we were at our FL beach condo and I had stressed or pulled a muscle and I went to a local “doc in a box” and he gave me #15 of Flexeril 10 mg, could not persuade him to give me a “better muscle relaxant”. Out of desperation, I had it filled. I took the first dose, and after one hr +/- I got up from the futon I was lying on and took a couple of steps and passed out and hit my head on our (hard)  ceramic flooring.  I was dealing with what is called orthostatic hypotension – when a pt changes positions – standing up from a seated or prone position, and the medication they are taking hinders the pt’s cardiovascular system to adjust the pt’s blood pressure to increase to maintain the pt’s “normal” blood pressure.   Needless to say, the other 14 tablets GOT TOSSED!

Tonmya (cyclobenzaprine HCl) is available as a sublingual tablet in a strength of 2.8mg. The usual dosing regimen for adults with fibromyalgia is:

Initial dose (Days 1–14): 2.8mg (1 sublingual tablet) once daily at bedtime.

Maintenance dose (Day 15 and onward): 5.6mg (2 sublingual tablets) once daily at bedtime, which is the maximum recommended dose.

For geriatric patients or those with mild hepatic impairment, the recommended and maximum dose is 2.8mg once daily at bedtime.

Estimate price for Tonmya 60 tabs/month $150-$200. Since Fibromyalgia is a CHRONIC CONDITION – Insurance/PBM will be ecstatic paying out $1,800-$2,400/month. Since this tab is designed to be placed under the tongue and not in a similar dose to any generic Cyclobenzaprine, I would expect a lot of Prior Authorization BS!

Generic Cyclobenzaprine 10 mg : max dose of 40mg 3xd price via www.single-care.com $7 to $25 for 120 doses, $84 to $300/yr.

FDA Approves First-in-Class Drug for Fibromyalgia

https://www.medscape.com/viewarticle/fda-approves-first-class-drug-fibromyalgia-2025a1000ltm

The FDA has approved cyclobenzaprine hydrochloride sublingual tablets (Tonmya, Tonix Pharmaceuticals), a first-in-class, nonopioid treatment for adults with fibromyalgia, a chronic pain syndrome that affects more than 10 million Americans, roughly 80% of whom are women.

The medication, taken once-daily at bedtime, targets nonrestorative sleep, a root cause of pain, fatigue, and brain fog in fibromyalgia. It’s the first new FDA-approved therapy for the treatment of fibromyalgia in over 15 years. Tonmya (formerly TNX-102 SL) is expected to be available in the fourth quarter of this year.

In two double-blind, randomized, placebo-controlled, phase 3 trials (RELIEF and RESILIENT) of nearly 1000 patients with fibromyalgia, sublingual cyclobenzaprine significantly reduced daily pain scores compared to placebo at 14 weeks (the primary endpoint).

In addition, a greater percentage of patients using the medication daily at bedtime experienced a clinically meaningful (≥ 30%) improvement in their pain after 3 months, compared to placebo.

Results of the RESILIENT trial were published online on July 8 in Pain Medicine.

A third phase 3 trial (RALLY) of more than 500 patients with fibromyalgia demonstrated greater but nonsignificant treatment effect with sublingual cyclobenzaprine compared to placebo.

Across all three trials, the medication was generally well tolerated with no serious side effects. The most common adverse events were local administration-site reactions including oral discomfort, dry mouth, and canker sores, as well as fatigue and drowsiness.

 

What to do when a pt survives very serious medical errors

Oh please…. many of u may have read, this past Wednesday i had a stent placed in my duodenum due to overuse of aspirin as im a pain patient, denied pain medication. Well after they installed it, i was taken to recovery where i was in literal agony an throwing up blood…. LOTS of blood. While there they gave me IV morphine. But they sent me home despita the hi pain an constant throwing up of blood. ALL OF THIS COULD HAVE BEEN AVOIDED HAD I BEEN PLACED IN PAIN MGT FROM BEGINNING. Anyway, once home, the Percocet 5mg was no way touching the level of pain an lord knows by then how much blood i lost so back to the ER we went, about 6pm. U know those green barf bags they have? I FILLED 3 of them while in ER. They let me go again, pain at agony level. So i go to sleep an at 6am, i get up to go to bathroom an blood came rushing down legs, floor in bathroom, alll over. Hubby said i lost about a pint of blood. Sooo much blood, i thought i was dying. So an ambulance was called an off i went to ER for 3rd time! Finally, they realized, im not there to get drugs an i mite actually be in danger! Long story short, they rushed me back into OR an removed the stent an spot where blood was gushing out, located. GET THIS… seems the gastro Dr installed this stent where an existing bleeding ulcer was an ripped it further plus the stent was RUBBING ON IT!!! Omg, no wonder the pain level was thru the roof! They gave me a transfusion. Well they finally kept me. Even tho the pain was greatly reduced by yanking that stent out, my poor stomach an abdomen still hurt. That nite, after they almost killed me, the SOB Dr cut a perc 5mg IN HALF, 2.5 mg an thats what they gave me!!! U would think theyd at least kept me comfortable! Still, no. I came home yesterday, limited food for 2 weeks an nothing for pain.

Im extremely ANGRY about all this. So ASK ME!! Why not ask ME, like ur article says!


The above I found on the web – a pt’s VERY BAD EXPERIENCE. Remember the 3rd largest cause of a person’s death is MEDICAL ERRORS, behind cancer & cardiovascular issues. I
I asked a AI program: It answered because I live in Indiana, but suspect that it will apply to all states:
If a pt is seriously harmed – but survived -in a hospital by an employee or a practitioner with hospital rights, who could the pt reach out to practitioner’s insurance- should they investigate the competency of the practitioner. The Joint commission for the hospital having a potential incompetent practitioner. The state insurance commissioner, the consumer protection dept of state governor – how many entities have oversight of such issues that a pt can take their concerns to: If a patient is seriously harmed in an Indiana hospital (but survives), there are several avenues and oversight bodies for addressing concerns about a potentially incompetent practitioner or unsafe conditions. Here’s a breakdown of entities a patient can contact, their roles, and related oversight mechanisms:
### 1. Hospital/Internal Complaints
– The first step is often the hospital’s **Patient Relations Department** or the Risk Manager. All hospitals should have internal procedures for investigating care concerns and practitioner competency.[1]
### 2. Indiana Department of Health (IDOH)
– Patients can file complaints about care provided in any licensed or certified healthcare facility with the IDOH, which investigates quality and safety issues.[2][3][4][5][1]
– IDOH also oversees the reporting and investigation of medical errors and adverse events that result in serious harm.[4]
### 3. Indiana Professional Licensing Agency/Medical Board
– The Indiana state **medical board** is responsible for licensing, investigating, and disciplining medical practitioners. Complaints about practitioner competency or unsafe practice are within their jurisdiction and can result in professional discipline, loss of license, or required remediation.[6][7][8]
### 4. The Joint Commission
– If the hospital is accredited by The Joint Commission, a complaint can be submitted for investigation into patient safety and care standards compliance.[9]
– The Joint Commission can initiate further investigations and require corrective actions if systemic problems are identified.
### 5. State Insurance Commissioner
– The **Indiana Department of Insurance** does not typically investigate practitioner competency but may oversee insurance issues, such as malpractice policy compliance or claim denials. Inquiries here are more appropriate for insurance-related grievances rather than care quality or safety.
### 6. Consumer Protection Office/Attorney General
– The Indiana Attorney General’s Consumer Protection Division accepts healthcare complaints, but typically those involving billing, fraud, or abusive practices—not standard-of-care issues. They may become involved if there’s deceptive or fraudulent conduct.
### 7. Peer Review Committees
– Hospitals maintain **peer review committees** that evaluate practitioner competency and investigate adverse outcomes. Findings may lead to internal corrective actions or be referred to state licensing boards.[8]
### 8. National Reporting Systems
– Some events (especially involving abuse, neglect, or criminal acts) require reporting to federal or national systems.
### Summary Table of Key Oversight Entities
| Oversight Entity | Approves/Disciplines Practitioner | Investigates Patient Harm | Accreditation/Safety Standards | Consumer Protection |
|———————————-|:——————————-:|:————————:|:—————————–:|:————————:|
| Hospital Patient Relations/Risk | Yes[1] | Yes[1] | Yes | No |
| Indiana Dept. of Health (IDOH) | Indirectly[7][5] | Yes[2][3][4] | Yes[4][5] | No |
| Medical Licensing Board | Yes[6][7][8] | Yes | No | No |
| The Joint Commission | Indirectly[9] | Yes | Yes | No |
| State Insurance Commissioner | No | No | No | Yes (insurance only) |
| Attorney General/Consumer Protect| No | No | No | Yes (fraud/deception) |
| Peer Review Committee | Yes[8] | Yes | Yes | No |
### Takeaways for a Harmed Patient
– **For serious harm possibly due to staff incompetence, patients (or family) should contact:**
– The hospital’s Patient Relations department/risk manager.
– The Indiana Department of Health.
– The Indiana Medical Licensing Board (for practitioner incompetence).
– The Joint Commission if the facility is accredited.
– The State Insurance Commissioner for insurance grievances (not for quality).
– The state Attorney General if fraud or abuse is suspected.
– **Hospitals are required to investigate internally (peer review), and practitioners are subject to oversight by state, regulatory, and accreditation bodies.**[7][1][4][6][8]
– **While multiple authorities may overlap, for care quality and practitioner competency, the IDOH and the Medical Licensing Board are the primary state oversight bodies, with additional oversight from internal committees and The Joint Commission for accredited hospitals.**

It is time to TAKE THE GLOVES OFF

When I opened my independent pharmacy in 1776, I had worked for a regional chain pharmacy and after working for them for ~ 3 yrs, I was promoted to pharmacy/store manager. I was told that I was the youngest manager in their 100+ yr history.  One+ year later, there was some changes at the chain and I decided to move on. I went to work for a franchisee of a national pharmacy chain of apothecary sized pharmacies – their stores were abt 1200 sq ft.

Come to find out the franchisee was in deep debt and owed the franchisor a lot of money. I had befriended the person who was supervisor for the territory my store was in for the Franchisor.

After working there for a few months, one Saturday another guy – that I knew from HQ- came into the pharmacy on a Saturday.  I asked the guy from corporate – “why are you working on Saturday”. The Franchisor HQ was in Milwaukee,WI.

He told me that they had called the Franchisee owner to Milwaukee to discuss a new promotional program, BUT the Franchisor was taking over the franchised pharmacies that he owned and the President of the Franchisor would be in next week to have a meeting with all the pharmacists working for this franchisee and the President instructed  the HQ guy to have the locksmith that was with him to change all the locks in all the stores and to GIVE YOU KEYS TO ALL THE STORES!

At that meeting the following week, I was told that I was being promoted to Regional Director for the KY stores. After a couple of years, I decided if I had to work this hard, maybe I should have my own pharmacy and get rid of all the headaches of being a “regional supervisor” and just open my little “one man pharmacy in 1976”. I found a vacant store front – abt 1200 sq ft – in a strip shopping center.

Over the following 20 yrs, we expanded into Home Medical Equipment (HME), bought the strip shopping center (23,000sq ft) and expanded our 1200 sq ft in the shopping center to about 5,000 sq ft and a off premise 2800 Sq ft warehouse to store, maintain, repair our rental inventory of HME equipment, and my “little one man pharmacy” had 18 employees.

During those years, I developed the work philosophy, “LEAD, FOLLOW, or GET THE HELL OUT OF MY WAY”

Barb and I are finding ourselves in the same place as many other chronic pain pts. Our PCP of almost 30 years has told us that he is retiring at the end of 2026. I fondly refer to our PCP as a Dr Marcus Welby https://en.wikipedia.org/wiki/Marcus_Welby,_M.D.

Barb is like most of the intractable chronic pain pts, she doesn’t have the stamina to fight on. We have already had three MDs tell us that “they are not comfortable” and two of them are in the same practice that our PCP is in and they have nearly 30 yrs of medical records on us. 

I have reached out to a handful of other individuals who claim that they are chronic pain advocates, that I thought would be the most receptive to considering some different paths.  So far their responses have been UNDERWHELMING – in fact it has been ZERO!  Wasn’t it Einstein’s quote that doing the save thing over and over and expected a different outcome, was his definition of INSANITY.

So it looks like I have to fall back on my previous SOP: “LEAD, FOLLOW, or GET THE HELL OUT OF MY WAY”

The practitioner that cut that woman’s opioids down to 1/3 of what she was taking and put a Buprenorphine Topical Patch on her and threw her into a hard, cold turkey withdrawal. Is going to be my test subject.

My mind is already laying out what has to be done, and very little of it is what has been tried in the past. Some may end up calling me CRAZY, but I am taking going to stay away from paths toward INSANITY!

 

Does the DOJ/DEA have similarities to terrorist organizations

can you compare the similarities and differences between the way that the DOJ/DEA extract money from businesses selling a legal product and the stories that I have heard about bullies or mafia would use threats to extract money out of the owners of store front businesses in order to keep their stores from being damaged?

The methods used by the DOJ/DEA to extract money from businesses through asset forfeiture and the tactics employed by mafia groups for extortion share core mechanisms of coercion and financial extraction but differ fundamentally in legality, oversight, and objectives. Below is a structured comparison:

Similarities

  1. Financial Coercion:

    • Both involve taking money or property from businesses under duress. The DEA uses civil asset forfeiture to seize cash or assets suspected of links to drug crimes without requiring a criminal conviction. Similarly, mafia groups demand “protection” payments from businesses under threats of violence or property damage.dea+4

  2. Lack of Proportional Proof:

    • DEA administrative forfeiture allows seizures based on probable cause alone, often without formal charges or judicial review. Mafia extortion relies solely on intimidation, with no legal burden of proof.ij+3

  3. Systemic Impact:

    • Both create climates of fear: Businesses face financial harm regardless of guilt (DEA) or compliance (mafia). For example, DEA seized $3.2 billion administratively since 2007, while Sicilian businesses paid thousands monthly to avoid mafia retaliation.good+3

Differences

Aspect DOJ/DEA Forfeiture Mafia Extortion
Legality State-sanctioned under laws like CAFRA; considered a law enforcement tooldea+1. Criminal activity; violates laws against racketeering, bribery, and violencebusiness-law-review.law.miami+2.
Methods Legal processes (e.g., notices, claims, court filings); owners can contest seizuresdea+1. Illegal intimidation: threats, bombings, murders, and forced “insurance” paymentsbusiness-law-review.law.miami+2.
Oversight Limited judicial review in administrative forfeiture; constitutional due process appliesdea+1. No oversight; victims rely on police protection, often ineffectivegood+1.
Purpose Aims to disrupt criminal enterprises (e.g., drug trafficking)dea. Expands criminal control; profits fund illicit operations (e.g., drugs, money laundering)business-law-review.law.miami+1.
Target Scope Focuses on assets tied to suspected crimes, even if business is legaldea+1. Targets any vulnerable business, regardless of legality (e.g., shops, construction)good+1.

Key Contrasts in Practice

  • Accountability: DEA seizures can be challenged in court, but 81% of cash seizures occur administratively without judicial scrutiny. Mafia victims have no legal recourse; non-compliance risks violence.anthropologyreview+3

  • Scale of Control: Mafias infiltrate entire sectors (e.g., Foggia, Italy, where businesses paid mandatory “premiums”), while DEA actions are geographically and jurisdictionally bounded.antimoneylaunderinglaw+2

  • Incentives: DEA forfeiture revenue funds law enforcement, whereas mafia profits fuel further crime.business-law-review.law.miami+2

In essence, both systems extract wealth through pressure, but the DEA operates within a legal framework—however flawed—while mafia tactics are purely criminal enterprises built on fear.

  1. https://www.dea.gov/operations/asset-forfeiture
  2. https://ij.org/inspector-general-report-dea-seized-3-2-billion-cash-without-judicial-oversight/
  3. https://business-law-review.law.miami.edu/law-and-disorder-battling-the-mafias-business-intrusion-in-italy/
  4. https://www.good.is/articles/shopkeeper-revolt-has-sicilian-mafia-on-the-run
  5. https://anthropologyreview.org/anthropology-archaeology-news/how-mafias-and-organized-crime-have-infiltrated-businesses-and-industries-worldwide/
  6. https://www.antimoneylaunderinglaw.com/2020/11/how-the-mafia-extorts-a-whole-city.html
  7. https://criminaldefenseattorneytampa.com/asset-seizure-asset-forfeiture/fighting-dea-forfeiture/
  8. https://www.reddit.com/r/AskHistory/comments/1il01ba/did_large_retail_chains_really_help_lead_to_the/
  9. https://www.dea.gov/sites/default/files/2025-05/2025%20National%20Drug%20Threat%20Assessment_Web%205-12-2025.pdf
  10. https://www.wsj.com/world/europe/pay-or-burn-an-italian-mafias-message-to-businesses-11644681601
  11. https://oig.justice.gov/news/doj-oig-releases-report-deas-income-generating-undercover-operations
  12. https://www.justice.gov/d9/pages/attachments/2020/02/09/fy_2021_dea_cj_revised_08242021.pdf
  13. https://oig.justice.gov/sites/default/files/reports/a20071.pdf
  14. https://oig.justice.gov/reports/2017/e1702.pdf
  15. https://oig.justice.gov/reports/DEA/a0706/final.pdf
  16. https://oig.justice.gov/news/doj-oig-releases-report-dojs-oversight-cash-seizure-and-forfeiture-activities
  17. https://www.ebsco.com/research-starters/economics/organized-crime-business
  18. https://academic.oup.com/edited-volume/38662/chapter/335789464?searchresult=1
  19. https://smart-retailer.com/is-your-company-being-bullied-by-customers/
  20. https://www.rescuecom.com/blog/index.php/david-milman/yelp-the-business-of-extortion/

Recently DOJ/DEA “extracted” millions or billions from CVS & Walgreens with only allegation that they filled MILLIONS of illegal prescriptions. There was apparently no real probable cause. In reality, CVS & Walgreens do not technically fill controlled medication Rxs, it is the pharmacists that work for these companies that determine if a Rx is valid, medically necessary. Those two chain pharmacies only have a license to operate Rx depts and must have a pharmacist on staff and at least one pharmacist who is considered “Pharmacist in Charge” and legally responsible to the state board of Pharmacy to make sure that the pharmacy follows the rules. Any idea why the DOJ/DEA goes after the pharmacy corp, other than a “money grab”

The DOJ and DEA’s pursuit of pharmacy corporations like CVS and Walgreens—rather than just individual pharmacists—has legal, regulatory, and practical foundations, and is not solely about extracting money, though the scale of settlements is certainly significant.

Legal and Regulatory Framework

  • Corporate Responsibility: Federal law, particularly the Controlled Substances Act (CSA), places responsibility on both pharmacists and the pharmacy entities themselves to ensure that prescriptions are valid and filled for a legitimate medical purpose. Pharmacists are considered the “last line of defense” against improper dispensing, but the law also holds the pharmacy business accountable for establishing and maintaining systems to prevent violations.pslhub+4

  • False Claims Act (FCA) Liability: When pharmacies seek reimbursement from federal healthcare programs for prescriptions that are not valid, they can be held liable under the FCA. This is a civil, not just criminal, liability and can apply to the corporation as a whole.bassberry+2

  • State and Federal Oversight: While state boards of pharmacy regulate individual pharmacists and require a Pharmacist-in-Charge (PIC) for each pharmacy, federal agencies like the DEA oversee the broader compliance of pharmacy businesses with federal controlled substance laws. The DEA can revoke a pharmacy’s registration if it finds systemic noncompliance.justice+2

Why Target the Corporation?

  • Systemic Issues and Culture: DOJ and DEA lawsuits allege that pharmacy chains fostered corporate cultures or policies that pressured pharmacists to fill prescriptions quickly, ignored red flags, or failed to provide pharmacists with necessary information to make informed decisions. For example, Walgreens has been accused of systematically pressuring pharmacists to fill prescriptions and preventing them from sharing information about known bad prescribers.medpagetoday+1

  • Scale of Violations: When millions of prescriptions are alleged to be filled improperly across thousands of locations, the government contends that the problem is not isolated to a few “bad apples” but is a systemic failure requiring corporate accountability.fiercehealthcare+2

  • Precedent and Deterrence: Targeting large corporations is seen as a way to send a message to the industry and deter similar behavior. The “corporate social responsibility” theory of liability is increasingly used to ensure that companies implement robust compliance programs.uspharmacist

  • Resource Allocation: It is more efficient for federal agencies to negotiate large settlements with corporations than to pursue thousands of individual pharmacists, especially when the alleged misconduct is widespread and involves corporate policies or practices.medpagetoday+1

Pharmacist vs. Corporate Responsibility

  • Pharmacist-in-Charge (PIC): While the PIC is legally responsible for the pharmacy’s compliance with state and federal laws, in large chains, many decisions are made at the corporate level, and the PIC may have limited authority over policies and staffing.pmc.ncbi.nlm.nih

  • Corporate Policies: The government alleges that corporate policies—such as performance metrics, staffing levels, and information-sharing practices—can create environments where pharmacists are discouraged from exercising their professional judgment.fiercehealthcare+1

Summary Table

Factor Pharmacist Responsibility Corporate Responsibility
Legal Basis State pharmacy law, CSA CSA, FCA, corporate liability
Enforcement Target Individual licensure, discipline Civil/criminal penalties, fines
Alleged Misconduct Filling invalid prescriptions Systemic policies, culture
Scale Individual or local National, thousands of locations
Purpose Professional accountability Industry deterrence, compliance

Conclusion

The DOJ and DEA go after pharmacy corporations because federal law holds them responsible for systemic compliance failures, and because large-scale violations are often rooted in corporate policies or culture, not just individual actions. While the financial settlements are substantial, the government’s stated goal is to protect public health and ensure compliance with laws designed to prevent opioid abuse and diversion. However, critics argue that the lack of clear regulatory guidance and the broad discretion given to prosecutors can make these actions feel punitive or arbitrary to some in the industry.corporate.walmart+4

  1. https://www.pslhub.org/learn/investigations-risk-management-and-legal-issues/us-government-sues-pharmacy-chains-cvs-and-walgreens-for-their-alleged-role-in-the-opioid-epidemic-7-march-2025-r12902/
  2. https://www.justice.gov/usao-edky/pr/barbourville-pharmacy-and-its-pharmacist-charge-pay-215000-resolve-alleged-0
  3. https://www.medpagetoday.com/pharmacy/pharmacy/113857
  4. https://www.bassberry.com/news/doj-brings-nationwide-false-claims-act-lawsuit-against-cvs-for-alleged-violations-of-controlled-substances-act/
  5. https://www.deadiversion.usdoj.gov/GDP/(DEA-DC-046R1)(EO-DEA154R1)_Pharmacist’s_Manual_DEA.pdf
  6. https://www.fiercehealthcare.com/regulatory/doj-alleges-walgreens-filled-billed-millions-unlawful-opioid-prescriptions-new-lawsuit
  7. https://pmc.ncbi.nlm.nih.gov/articles/PMC8075149/
  8. https://www.fiercehealthcare.com/retail/walgreens-will-pay-350m-settlement-doj-resolve-opioid-prescription-lawsuit
  9. https://www.uspharmacist.com/article/corporate-social-responsibility-justice-without-due-process
  10. https://corporate.walmart.com/news/2020/12/22/a-misguided-department-of-justice-lawsuit-forces-pharmacists-between-patients-and-their-doctors
  11. https://www.justice.gov/opa/pr/walgreens-agrees-pay-350m-illegally-filling-unlawful-opioid-prescriptions-and-submitting
  12. https://www.justice.gov/archives/opa/pr/justice-department-files-nationwide-lawsuit-alleging-walgreens-knowingly-filled-millions
  13. https://www.reuters.com/legal/government/walgreens-challenges-dea-restrictions-opioids-dispensing-2025-01-17/
  14. https://www.dea.gov/press-releases/2022/12/15/dea-serves-order-show-cause-truepill-pharmacy-its-involvement-unlawful
  15. https://www.congress.gov/crs-product/LSB10307
  16. https://www.deadiversion.usdoj.gov/pubs/pressreleases/Diversion-News-January-2025.pdf
  17. https://www.dea.gov/press-releases/2024/02/07/dea-announces-settlement-morris-dickson-co-llc
  18. https://www.cnn.com/2025/01/18/business/walgreens-doj-opioid-prescriptions
  19. https://www.ajmc.com/view/attorneys-general-sue-walgreens-over-dangerous-prescription-practices
  20. https://www.dea.gov/drug-information/csa
  21. https://www.drugtopics.com/view/corresponding-responsibility-of-pharmacies-dea-to-uphold-controlled-substances-act
  22. https://www.rxrelief.com/blog/as-a-pharmacist-in-charge-you-need-to-protect-yourself-legally/
  23. https://dsc.duq.edu/cgi/viewcontent.cgi?article=2809&context=dlr
  24. https://www.pharmacytimes.com/view/court-addresses-liability-in-dispensing-controlled-substances
  25. https://federal-lawyer.com/doj-targets-black-market-prescription-drug-diversion-signaling-possible-new-enforcement-trend/
  26. https://www.dea.gov/press-releases/2024/08/29/sweeping-dea-operation-targets-pharmacy-burglaries-and-illegal-sale
  27. https://www.jdsupra.com/legalnews/recent-doj-enforcement-actions-signal-5245179/
  28. https://federal-lawyer.com/healthcare/healthcare-compliance/dea-matters/pharmacy-red-flags-opioid-medications/
  29. https://corporateinvestigation.com/dea-drug-diversion-investigations/

Should the question be ASKED?

This simple math would strongly suggest that the war on drugs has not basis in MATH. It is pretty common knowledge that addiction – regardless of what a person is demonstrating addictive behavior about – There is typically stated that addiction has a substantially underlying mental health issues. The Graph below that there is abt 4.8 million people =>12 y/o are dealing with OUD. It is routinely stated that there is some 100 million people dealing with chronic pain and others claim that certain opioids are EXTREMELY ADDICTING.

The number of prescription opioid doses dispensed in the United States each year has varied but has been estimated to be in the tens of billions of dosage units annually. The DEA reported figures ranging from 12 to 17 billion dosage units dispensed at the retail level in recent years.

over 120 million opioid prescriptions dispensed annually

SO, if – as some claim – that many/all opioids are EXTREMELY ADDICTING, why is there only 4.8 million people dealing with OUD?

The question has to be asked? Why are we refusing to treat chronic pain pts, if the numbers would suggests that we are denying the majority of chronic pain pts from having their chronic medical  issues properly treated, just like we treat all other people with chronic medical issues. Since most of the chronic pain pts are DISABLED, why is our system discriminating on this category of disabled  people?

Could it be that our DOJ/DEA has had an agenda since 1970 and it is unthinkable for bureaucrats to admit they have been wrong? When is the last time anyone has heard a bureaucrat admit they were wrong?

In 2024, 4.8M people (12 or older) had a past year opioid use disorder. Of those, 17% (818,000 people) received medications for opioid use disorder (MOUD) in the past year. More data in the 2024 hashtagNSDUH: samhsa.gov/data/nsduh