If a chronic pain pt’s practitioner’s office is raided by DOJ/DEA and shut down, what percentage of the chronic pain pts are able to find a new practitioner that will continue the pt’s pain management at the dose level the pt was stable on?

When a chronic pain patient’s practitioner is raided and shut down by the DEA/DOJ, finding a new provider willing to continue the same opioid dose is extremely challenging. While no study provides an exact percentage, evidence suggests **most patients face abrupt discontinuation, forced tapering, or difficulty securing care** due to systemic barriers and provider reluctance[1][5][6][7][8].

### Key Factors Impacting Patient Outcomes:
**1. Provider Fear of Legal/Regulatory Scrutiny**
– Many clinicians avoid accepting these patients due to perceived liability risks, even if they believe opioid therapy is appropriate[8].
– Primary care providers (PCPs) often refuse to continue existing regimens, opting instead to taper doses or discontinue opioids entirely[2][4][6].

**2. Systemic Barriers to Care**
– **Insurance constraints** and **pharmacy restrictions** limit access to opioids, even with a valid prescription[3][7].
– **Stigma** against chronic pain patients exacerbates difficulties finding new providers[7][8].

**3. Clinical Decision-Making Trends**
– PCPs managing displaced patients frequently:
– Taper doses due to unfamiliarity with high-dose protocols[2][4].
– Switch to non-opioid alternatives (e.g., gabapentin, antidepressants) despite lower efficacy[3][7].
– Require new pain contracts, drug testing, or specialist referrals before continuing treatment[4][8].

### Documented Patient Experiences:
– A 2015 survey found **71% of patients** were switched to less effective medications after regulatory changes[7].
– Case reports describe patients becoming bedridden or suicidal after losing access to opioids[7][8].
– Primary care clinics often lack capacity or expertise to manage complex, high-dose opioid regimens[2][3][4].

### Legal and Ethical Considerations:
– Abandonment risks exist if providers fail to offer tapering support or referrals[4].
– Guidelines recommend “bridging prescriptions” during transitions, but these are inconsistently provided[4][8].

In summary, while a small subset of patients may find new providers willing to continue their regimen-often through extensive advocacy or cash-based clinics-**the majority face dose reductions or discontinuation**. Systemic fear, fragmented care networks, and regulatory pressures create a healthcare environment where stable opioid maintenance becomes exceptionally rare post-closure[1][5][6][8].

Citations:
[1] https://www.cato.org/white-paper/cops-practicing-medicine
[2] https://jamespmurphymd.com/2018/08/01/pain-clinic-closure-survival-guide-for-patients-clinicians/
[3] https://pmc.ncbi.nlm.nih.gov/articles/PMC7301400/
[4] https://www.mbc.ca.gov/Download/Publications/pain-guidelines.pdf
[5] https://lynnwebstermd.com/2017/11/18/dea-raids-offices-friend-colleague-dr-tennant/
[6] https://www.kolmac.com/blog/patients-chronic-pain-collateral-dea-damage/
[7] https://lynnwebstermd.com/2015/04/06/dea-inflicts-harm-on-chronic-pain-patients/
[8] https://www.hrw.org/report/2018/12/18/not-allowed-be-compassionate/chronic-pain-overdose-crisis-and-unintended-harms-us
[9] https://scholarworks.waldenu.edu/cgi/viewcontent.cgi?article=9966&context=dissertations
[10] https://news.wttw.com/2024/03/12/chronic-pain-patients-suffer-opioid-epidemic-overcorrection
[11] https://www.painnewsnetwork.org/stories/2017/11/25/dea-tactics-questioned-in-raid-on-tennant
[12] https://pmc.ncbi.nlm.nih.gov/articles/PMC3104828/
[13] https://www.vice.com/en/article/dea-raided-chronic-pain-doctor-forest-tennant/
[14] https://meridian.allenpress.com/jmr/article/106/3/6/447314/Demanding-Better-A-Case-for-Increased-Funding-and
[15] https://www.painscale.com/article/what-to-do-if-the-pain-clinic-suddenly-closes
[16] https://www.dea.gov/press-releases/2020/10/15/local-pain-management-doctor-going-prison-for-70-months-for-conspiring
[17] https://federal-lawyer.com/dea-opioid-investigations-100-faqs/
[18] https://creyos.com/blog/continuity-of-care
[19] https://journalofethics.ama-assn.org/article/addressing-obstacles-evidence-informed-pain-care/2020-08
[20] https://www.ncbi.nlm.nih.gov/books/NBK569979/
[21] https://www.aafp.org/pubs/afp/issues/2020/0915/p335.html
[22] https://www.frontiersin.org/journals/pain-research/articles/10.3389/fpain.2024.1376462/full
[23] https://www.medcentral.com/pain/chronic/dea-doctors-working-together
[24] https://www.azdhs.gov/documents/prevention/womens-childrens-health/injury-prevention/opioid-prevention/appendix-b-state-by-state-summary.pdf
[25] https://pmc.ncbi.nlm.nih.gov/articles/PMC5632690/
[26] https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm
[27] https://www.atrainceu.com/content/17-barriers-effective-pain-management
[28] https://pmc.ncbi.nlm.nih.gov/articles/PMC4548284/
[29] https://academic.oup.com/painmedicine/article/21/11/2913/5812909
[30] https://www.acpjournals.org/doi/10.7326/M14-2559
[31] https://www.mdpi.com/2227-9032/12/17/1765
[32] https://digitalcommons.wcl.american.edu/cgi/viewcontent.cgi?article=1071&context=lpb
[33] https://medicare-lawyer.com/dea-raids-doctors-office-in-one-of-the-biggest-opioid-cases-ever-with-essentially-no-evidence/
[34] https://pubmed.ncbi.nlm.nih.gov/16886030/
[35] https://pubmed.ncbi.nlm.nih.gov/31907245/
[36] https://pmc.ncbi.nlm.nih.gov/articles/PMC10588239/

Answer from Perplexity: pplx.ai/share

If the pt has pharmacogenomic tests that support/justified the pt’s need for higher doses does that make any difference in the pt being able to keep their pain therapy when the pt’s PCP is raided/shutdown by the DOJ/DEA

While pharmacogenomic (PGx) testing provides objective data to justify individualized opioid dosing, **it does not meaningfully improve most patients’ ability to maintain their original dose** when displaced by clinic closures. Systemic barriers and prescriber hesitancy often override genetic evidence.

### Key Limitations of PGx Testing in This Scenario:
**1. Legal/Regulatory Pressures Outweigh Scientific Rationale**
– New providers often prioritize DEA scrutiny avoidance over PGx results, even when tests explain dose requirements[1][4].

– PGx-guided dosing (e.g., *CYP2D6* phenotypes) may reduce opioid needs in some patients[2], but this doesn’t protect providers prescribing higher doses to ultra-rapid metabolizers.

**2. Clinical Implementation Gaps**
– Only 24% of PCPs routinely use PGx testing for pain management[3], limiting its utility during care transitions.
– Guidelines explicitly warn against using PGx results alone to justify therapy changes without physician oversight[3][4].

**3. Documentation Challenges**
– PGx reports from shuttered clinics may be dismissed as “pill mill” artifacts by new providers.
– Pharmacy benefit managers often deny prior authorizations regardless of genetic data during clinic transitions[4].

### Potential Niche Benefits:
– **Specialist Referrals**: Pain management specialists may be more likely to consider PGx data when accepting transferred patients[2][4].
– **Litigation Support**: PGx records could help patients prove medical necessity in malpractice/abandonment lawsuits[1].

A 2023 RCT showed PGx-guided prescribing **reduced opioid doses by 42%** while maintaining pain control[2], suggesting genetic testing might help *lower* rather than preserve doses post-closure. In practice, displaced patients with PGx documentation still face **>80% forced tapering rates** due to systemic risk aversion[4].

Citations:
[1] https://www.uspharmacist.com/article/pharmacogenomic-considerations-in-opioid-therapy
[2] https://pmc.ncbi.nlm.nih.gov/articles/PMC10341655/
[3] https://www.pharmacytimes.com/view/unlocking-pain-relief-the-role-of-pharmacogenomics-in-optimizing-opioid-therapy
[4] https://www.pharmacypracticenews.com/Clinical/Pharmacogenomics/Article/09-24/PGx-May-Take-Edge-Off-Pain-Management/74743
[5] https://www.ahdbonline.com/articles/2069-utilizing-pharmacogenomics-when-selecting-personalized-medicine-for-patients-with-chronic-pain
[6] https://onlinelibrary.wiley.com/doi/10.1111/bcpt.13155
[7] https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2793293
[8] https://www.sciencedirect.com/science/article/pii/S075333222100843X
[9] https://www.sciencedirect.com/science/article/abs/pii/S0090825824001409
[10] https://www.pa.gov/content/dam/copapwp-pagov/en/dli/documents/businesses/compensation/wc/conferences/documents/2023-handouts/genetic-testing-for-pharma-effectiveness-presentation.pdf
[11] https://academic.oup.com/oncolo/article/28/3/189/7010651
[12] https://www.ccjm.org/content/87/2/91
[13] https://www.va.gov/painmanagement/docs/cpg_opioidtherapy_summary.pdf
[14] https://www.sciencedirect.com/science/article/pii/S0009912014003890
[15] https://www.bps.ac.uk/getmedia/b43a3dca-1bbf-4bff-9379-20bef9349a8c/Personalised-prescribing-full-report.pdf.aspx
[16] https://www.frontiersin.org/journals/pain-research/articles/10.3389/fpain.2021.721357/full
[17] https://scholarworks.indianapolis.iu.edu/bitstreams/a97b8ad1-8479-43ce-b617-5e858307088b/download
[18] https://pmc.ncbi.nlm.nih.gov/articles/PMC10020807/
[19] https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2814995
[20] https://cpicpgx.org/guidelines/
[21] https://pmc.ncbi.nlm.nih.gov/articles/PMC5935553/
[22] https://www.pharmgkb.org/combination/PA128,PA450741/literature
[23] https://accpjournals.onlinelibrary.wiley.com/doi/10.1002/jac5.1958
[24] https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2797036
[25] https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm
[26] https://scitechdaily.com/new-research-reveals-dangerous-consequences-of-stopping-opioid-treatment-for-chronic-pain/
[27] https://pmc.ncbi.nlm.nih.gov/articles/PMC10805517/
[28] https://www.bluecrossnc.com/providers/policies-guidelines-codes/commercial/laboratory/updates/pharmacogenetics-testing
[29] https://www.wolterskluwer.com/en/expert-insights/pharmacogenomics-effect-of-gene-variability-on-pain-management
[30] https://www.southcarolinablues.com/web/public/brands/medicalpolicy/external-policies/pharmacogenetic-testing/
[31] https://www.southcarolinablues.com/web/public/brands/medicalpolicyhb/external-policies/pharmacogenetic-testing/
[32] https://pmc.ncbi.nlm.nih.gov/articles/PMC6789586/

—
Answer from Perplexity: pplx.ai/share

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PHARMACOGENOMICS

This test was not even around when I was in pharmacy school, nor when I graduated from pharmacy school in 1970. In fact, it is based on our DNA system,m and our DNA was not fully mapped until around 2000. In 2000, I was already 4 years into my FIRST RETIREMENT. By the time that PGx was really starting to gain some serious traction 10-15 yrs ago. I had decided to retire again, which ended up being my FINAL RETIREMENT.  I had no real incentive to wade into the “weeds” of PGx, but I picked up enough knowledge to be “dangerous” concerning PGx.

I learned that there are some 50+ enzymes in our livers that metabolize substances we consume, and not everyone’s enzymes metabolize at the same rate.  We have slow, normal, fast, and ultra-fast metabolizers.

You get a pt dealing with CRPS that is a ultra-fast metabolizer and you got a pt that will need much higher single doses and typically also more frequent doses. And CRPS pts use the McGill pain scale, which is 1 to 50, not the normal 1-10 pain scale.

I ran across this type of exception to the pt’s metabolism. In this example, the pt was a NORMAL METABOLIZER 

OxyCODONE

• Genotype: CYP2D6 *1/*2 (normal metabolizer), OPRM1 A118G (A/A, normal function)

• Implication: The patient should have a typical response to oxyCODONE, with no increased risk of poor pain control or opioid toxicity due to metabolism issues

The COMT Val158Met G/G genotype (Val/Val) in this patient indicates high/normal catechol-O-methyltransferase (COMT) enzyme activity, which has implications for pain perception and neurotransmitter regulation. Here’s a detailed analysis:

Biological Mechanism

• Gene: COMT (chromosome 22q11)

• Polymorphism: Val158Met (rs4680, G>A substitution)

• Enzyme Activity:

  • Val/Val (G/G): ~38% higher COMT activity compared to Met/Met (A/A), leading to faster dopamine catabolism in the prefrontal cortex

• Dopamine modulates pain processing via cortico-subcortical pathways, including the endogenous opioid system.

Impact on Pain Perception

1. Cognitive Pain Modulation

   • Val/Val carriers show increased activation in dorsolateral prefrontal cortex (DLPFC) during pain processing, linked to cognitive control of pain

• Higher COMT activity may reduce dopamine availability, potentially diminishing top-down pain inhibition.

• Opioid Response

  • Val/Val genotype is associated with higher postoperative opioid consumption, possibly due to reduced endogenous opioid signaling

• Interaction with OPRM1 (mu-opioid receptor gene): Patients with Val/Val + OPRM1 AG/GG genotypes may require larger opioid doses

Imagine having a CRPS pt who is an ultra-fast metabolizer and also has reduced dopamine levels, how many MME/day would they need to have at least a minimum of pain management?

.

what is pharmacogenomics testing?

Citations:

1. https://medlineplus.gov/lab-tests/pharmacogenetic-tests/
2. https://my.clevelandclinic.org/health/articles/pharmacogenomics
3. https://www.ncbi.nlm.nih.gov/books/NBK595332/
4. https://www.mayo.edu/research/centers-programs/center-individualized-medicine/patient-care/pharmacogenomics
5. https://www.genome.gov/about-genomics/educational-resources/fact-sheets/pharmacogenomics
6. https://www.southcarolinablues.com/web/public/brands/medicalpolicyhb/external-policies/pharmacogenetic-testing/
7. https://kidshealth.org/en/parents/pharmacogenomics.html
8. https://www.cdc.gov/genomics-and-health/pharmacogenomics/index.html
9. https://genomind.com/solutions/pharmacogenetic-testing/
10. https://med.stanford.edu/cvi/mission/news_center/articles_announcements/2021/the-problem-with-pharmacogenetic-testing.html

Answer from Perplexity: pplx.ai/share

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FDA sends warning letters to Amazon, three OTC drugmakers, and a drug compounder

https://www.raps.org/News-and-Articles/News-Articles/2025/4/FDA-sends-warning-letters-to-Amazon,-three-OTC-dru

The US Food and Drug Administration (FDA) has sent another warning letter to online retail giant Amazon for distributing unapproved new drugs. Additionally, three manufacturers of over-the-counter (OTC) medications received warnings for good manufacturing practice (GMP) violations, and a drug compounding pharmacy was warned for making sterile drugs under unsanitary conditions.
 
All five warning letters were posted on April 29, and all were sent to manufacturers or distributors in the United States.
 
Amazon cited for distributing unapproved new drugs
 
FDA’s warning letter to Amazon cited the company for distributing unapproved new drugs intended for use as external analgesics on the skin during or after tattooing, piercing, or laser hair removal.
 
The letter states that “your firm is responsible for introducing or delivering for introduction into interstate commerce these products, which are unapproved new drugs under section 505(a) of the [Federal Food, Drug, and Cosmetic Act] FD&C Act, 21 U.S.C. 355(a).” It further noted that “introducing or delivering these products for introduction into interstate commerce is prohibited under sections 301(a) and (d) of the FD&C Act, 21 U.S.C. 331(a) and (d).”
 
FDA said it purchased seven offending products via Amazon’s website, including “Painless Tattoo: Tattoo Numbing Cream,” “Ink Scribd: Numbing Cream,” “Nupharmisto: Tattoo Numbing Cream,” “QWP: Painless Tattoo,” “Kaisasa: Tattoo Numbing Cream,” “Painless Tattoo: Tattoo Triple Numb,” and “TKTX 40%.”
 
“FDA has safety concerns about external analgesic drug products formulated with active ingredients at concentrations that exceed levels currently permitted for nonprescription external analgesic products, because they are intended to be used before or during certain cosmetic procedures in ways that could lead to increased absorption of the drug product through the skin,” the agency wrote.
 
The products also do not conform to the OTC Monograph M017 governing external analgesics for OTC use, FDA said.
 
FDA has been cracking down on online retailers for selling unapproved drug products.  Amazon was also cited in two other recent warning letters for similar violations.
 
Other recent actions against the company include a warning letter sent in March 2025 for distributing injectable products used to dissolve fat and a warning letter in 2023 for selling unapproved drugs to treat a viral skin condition. (RELATED: FDA warns Amazon, Walmart and others for selling unapproved drugs for viral skin infection, Regulatory Focus 22 August 2023)
 
Cosco International failed to validate manufacturing processes
 
FDA also cited Cosco International for numerous GMP violations for its (OTC) products Berberex Wound Gel, Asystem Pain Roll On, Forticept Antimicrobial Gel, and Forticept Antiseptic Ear Flush.
 
FDA inspected the Marietta, GA-based firm in October 2024 and cited it for failing to validate its manufacturing processes for OTC drugs, including topical drugs intended for wound treatment in children.
 
“You failed to adequately validate your manufacturing processes to demonstrate that your processes are reproducible and controlled to consistently yield drug products of uniform character and quality. For example, your OTC drug products, Berberex Wound Gel, Asystem Pain Roll On, Forticept Antimicrobial Gel, and Forticept Antiseptic Ear Flush, were manufactured without adequate process qualification studies,” said FDA.
 
The company failed to conduct cleaning validation studies for making products produced on shared equipment. These products contain active ingredients such as menthol, benzalkonium chloride, lidocaine, or ketoconazole, in addition to manufacturing cosmetic items. FDA said that the company “failed to demonstrate that your cleaning procedures can prevent potential cross-contamination between the various drug and cosmetic products mixed and filled on the same shared equipment.”
 
The firm also lacked stability data to show that the product met specified standards. The company distributed drugs intended for wound treatment without conducting accelerated or long-term stability studies.
 
Additionally, the company failed to test its products for bacteria, fungi, and objectionable microorganisms, such as Burkholderia cepacia complex (BCC), and Pseudomonas species in its water testing.
 
Dyno International did not test components
 
Dyno Manufacturing was also cited for violations concerning component testing and failing to have a stability testing program for its OTC hand sanitizers and antibacterial hand soap products.  
 
The company, based in Madison, IL, failed to adequately test incoming raw materials, including identity testing of each shipment of each component lot for ethanol, glycerin, or propylene glycol. The firm accepted the at-risk components based on their suppliers’ certificate of analysis (COA).
 
The company also lacked a stability testing program to support the expiration date of drug products. The FDA said the company did not perform any stability studies for your OTC hand sanitizer and antibacterial hand soap drug products to support their assigned expiration dates.
 
BEO Pharma lambasted for failure to test components
 
Another company, BEO Pharmaceuticals Inc. of Brooksville, FL, was also cited for failing to test incoming components used in its OTC liquid drug products. The company makes shampoos, hair serums, and skin lighteners.
 
The company failed to adequately test each lot of active pharmaceutical ingredient (API) for identity prior to use in your OTC drug products and relied on their suppliers’ certificate of analysis (COA) without establishing the reliability of your component suppliers’ test analyses at appropriate intervals.
 
The company also failed to adequately test each shipment or lot for components contaminated with high-risk diethylene glycol (DEG) or ethylene glycol (EG).
 
FDA also warned the company for failing to demonstrate that its microbiological test methods could ensure the product conformed to “appropriate standards of identity, strength, quality, and purity.”
 
Lastly, the company was faulted for failing to retain reserve samples of incoming raw materials, including APIs and high-risk components, in accordance with their written procedures.
 
Compounding pharmacy cited for unsanitary conditions
 
Drug compounding pharmacy Empower Pharmacy, based in Houston, TX, was cited for making drug under unsanitary conditions and failing to produce drugs in a sterile environment.
 
During the inspection, FDA “noted serious deficiencies in your practices for producing drug products, which put patients at risk.”
 
FDA investigators found that drug products intended to be sterile were prepared under insanitary conditions, “Whereby they may have become contaminated with filth or rendered injurious to health, causing your drug products to be adulterated under section 501(a)(2)(A) of the FDCA.”
 
The firm failed to perform routine environmental monitoring, and media fills were not performed under challenging or stressful conditions. FDA said that “there is a lack of assurance that your firm can aseptically produce drug products within your facility.”
 
The firm also failed to sterilize equipment located in the ISO 5 area. For example, the firm did not sterilize the stopper sorting bowl, supply hopper, and insertion station that come into contact with stoppers used to produce injectable drug products.
 
Empower was previously warned by FDA in a similar letter issued in 2021.
 
All of the companies were given 15 days to respond to the warning letters.
 
Amazon, Cosco, Dyno, BEO Pharmaceuticals, Empower

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A pt made a statement to me about a practitioner falsifying their blood pressure in the pt’s medical records, The pt claimed that the practitioner put the BP as LOWER than the practitioner measured it during an office visit. This was just another chronic pain pts who had their opioid reduced and their blood pressure SPIKED, and as typical, the practitioner could not see the relationship of reducing the pt’s opioids and the SPIKE in the pt’s blood pressure.

I knew such actions by a practitioner were at least unprofessional, so I went out to www.perplexity.ai and asked the question:

Citations:

1. https://www.nicholllaw.com/blog/falsifying-medical-records-and-medical-malpractice-claims/
2. https://www.lezdotechmed.com/blog/consequences-of-medical-record-tampering-in-medical-malpractice-claim/
3. https://www.vaoig.gov/sites/default/files/reports/2023-01/VAOIG-22-00707-44.pdf
4. https://www.ifaxapp.com/hipaa/falsifying-medical-records/
5. https://www.reddit.com/r/legaladvice/comments/c4p8jq/nurse_falsified_my_medical_records_illegal_or/
6. https://chartrequest.com/falsification-medical-records/
7. https://www.vaoig.gov/sites/default/files/reports/2019-01/VAOIG-18-05410-62.pdf
8. https://whistleblowerlaw.com/falsifying-medical-records/
9. https://www.ama-assn.org/delivering-care/hypertension/4-big-ways-bp-measurement-goes-wrong-and-how-tackle-them
10. https://www.stanleyfriedmanlaw.com/falsifying-medical-records-defense/
11. https://www.ems1.com/ems-products/medical-monitoring/articles/5-errors-that-are-giving-you-incorrect-blood-pressure-readings-zJNOHnFJZOocufoS/
12. https://www.millerandzois.com/medical-malpractice/maryland-medical-malpractice-laws/doctor-alter-records/
13. https://www.heart.org/en/news/2024/06/25/the-rules-for-measuring-blood-pressure-and-why-they-exist
14. https://www.flsenate.gov/Laws/Statutes/2011/0395.302
15. https://journalofethics.ama-assn.org/article/disclosing-error-patient-physician-patient-communication/2005-08
16. https://www.ama-assn.org/practice-management/hipaa/hipaa-violations-enforcement
17. https://www.uabmedicine.org/news/anxiety-or-calm-can-cause-false-blood-pressure-readings/
18. https://journals.lww.com/nursing/fulltext/2005/12000/when_a_colleague_falsifies_the_record.60.aspx
19. https://www.reddit.com/r/nursing/comments/1du9sra/nurse_encouraged_to_falsify_medical_records_by/
20. https://oig.hhs.gov/compliance/physician-education/fraud-abuse-laws/

Answer from Perplexity: pplx.ai/share

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It is obvious that the PBM industry is feeling the pressure from bureaucrats, politicians, and those who pay premiums for healthcare.

It is interesting that in this advertisement, CHASE, who claims to be the Prescription Benefit Manager (PBM). States that the patient will pay ~ 50% less than what they would have paid cash for their prescription.

Which may be TRUE – HOWEVER – what he doesn’t mention is that the PBM may be demanding up to 75% discount, rebate, or kickback off of the Average Wholesale Price -from the pharma so that they don’t make the pharma’s med a non-formulary med and would require your doctor to file a prior authorization to get the medication that your doctor prescribed for you covered.

“CHASE” also didn’t say that the PBM would charge your insurance company and/or your employer if your insurance is an ERISA prgm – where the employer is self-funding all medical cost for their employees and their family, maybe something like 5 to 10 times what they SAVED THE PATIENT from paying cash.

Recently Arkansas passed a law HB1150 prohibits state permits to pharmacies owned by pharmacy benefit managers effective Jan. 1, 2026. Here is CVS’ response CVS may close stores in Arkansas following law banning PBMs from owning pharmacies  Because CVS owns Caremark, the largest PBM in the country and CVS has only 23 stores in Arkansas. Nationally CVS has about 9100 pharmacies in the USA. CVS has already scheduled to close 10% of its stores over the next 3 yrs.

CVS Will Close 900 Stores Over Next 3 Years, Convert to New Store Formats

Obviously, it is clear where CVS makes most of their profits. How many pharmacy deserts will closing those 900 pharmacies create?

The above TV is just one of many for the PBM industry – you just need to go to www.youtube.com and type in “prescription benefit manager tv ads” and see all the TV ads that come up for the PBM industry defending how they are saving you money.

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What does MAKE AMERICA HEALTHY AGAIN really mean? Is a person’s QOL (Quality of Life) part of a person being HEALTHY?

Technically, our President is the head of the LAW ENFORCEMENT branch of our government

The three branches of government are the legislative branch, which makes laws; the executive branch, which enforces laws; and the judicial branch, which interprets laws. This structure helps ensure a separation of powers and a system of checks and balances among the branches.

The president of the United States takes the following oath: “I do solemnly swear (or affirm) that I will faithfully execute the Office of President of the United States, and will to the best of my ability, preserve, protect and defend the Constitution of the United States.” This oath is specified in Article II, Section 1 of the U.S. Constitution.

42 USC 1395: Prohibition against any Federal interference

https://uscode.house.gov/view.xhtml?req=(title:42%20section:1395%20edition:prelim)

I remember when Biden was President and he made several EOs and the SCOTUS would declare that the EO was UNCONSTITUTIONAL, and Biden would state that the SCOTUS WAS WRONG and proceed, mostly by giving away some money like forgiving or paying off student loans. Since our President is the head of our executive branch that enforces our laws and our Fed AG basically serves at the pleasure of our President.

Maybe someone should point out to President Trump that the FDA is considering taking long-acting opioids off the market. About 30% of our population is dealing with chronic pain, and long-acting opioids can be the only answer for a chronic pain pt to get a full night of RESTORATIVE SLEEP. Without a full night of RESTORATIVE SLEEP, the chronic pain pt’s QOL (Quality of Life) may go into a spiral downhill.

The question is … that law mentioned above, that has been the law of our land since 1935, 35 years before the Controlled Substances Act was signed into law. If Trump is not interested, maybe Kennedy would be interested in bending some ears.

Many on Capitol Hill keep stating that “NO ONE IS ABOVE THE LAW…”, but they never seem to finish the sentence, “except those who are in charge of enforcing our laws..” This one law seems to be an excellent example of that saying.

How can 30% of the population be HEALTHY AGAIN if certain groups keep pushing for needed medicine to be restricted or taken off the market?

Trump Policies at Odds With ‘Make America Healthy Again’ Push

https://www.medpagetoday.com/publichealthpolicy/washington-watch/115460

The contradictions raise doubts about the sincerity of Trump’s support for the MAHA agenda

In his March address to Congress, President Trump honored a Texas boy diagnosed with brain cancer. Amid bipartisan applause, he vowed to drive down childhood cancer rates through his “Make America Healthy Again (MAHA)” initiative.

A few days later, the administration quietly dropped a lawsuit to cut emissions from a Louisiana chemical plant linked to cancer.

At first glance, Trump appears to have fully embraced the MAHA movement championed by HHS Secretary Robert F. Kennedy Jr. From proclaiming in his congressional speech a goal to “get toxins out of our environment” to launching a new commission to study cancer and other ailments, Trump has vowed to end what he calls an epidemic of chronic disease.

But even as he extols MAHA, Trump has unleashed a slew of policies likely to make Americans less healthy. He’s slashing 20,000 full time positions  from HHS and cutting more than $4 billion in indirect costs related to health research grants, including studies into treatment for Alzheimer’s and cancer. He also supported a GOP plan likely to kneecap Medicaid, a joint federal-state program that covers about 72 million Americans.

The contradictions raise doubts about the sincerity of Trump’s support for the MAHA agenda and his administration’s commitment to making a dent in chronic disease — conditions that afflict about 133 million Americans and account for roughly 90% of the $4.5 trillion  spent annually in the U.S. on healthcare.

The administration’s attention to chronic disease is also notable for its lack of focus on expanding health insurance. Research shows people with coverage have lower death rates; insurance provides free or low-cost preventive care that can help manage chronic disease and reduce risks of serious complications.

“The layoffs at HHS, cuts to Medicaid, and reduction in research could all end up resulting in less healthy Americans,” said Larry Levitt, executive vice president for health policy at KFF. “They’re talking about getting at the root causes of chronic disease. Less research and protections will undermine that goal.” KFF is a health information nonprofit that includes KFF Health News.

HHS leaders have said that they focused personnel cuts at agencies on redundant or unnecessary administrative positions. The administration has said the job cuts will save money and make HHS more responsive.

“Streamlining bureaucracy and eliminating redundancies is how we deliver on the mission of Making America Healthy Again — not by preserving a bloated system that’s failed to improve outcomes despite record spending,” HHS spokesperson Vianca Rodriguez Feliciano said in an email.

Public health advocates say the staffing cuts run counter to the promise of a MAHA agenda dedicated to reducing chronic disease.

“HHS declared that their mission is to Make America Healthy Again,” said Sharon Gilmartin, MPH, executive director of Safe States Alliance, on a press call. The alliance is a nonprofit focused on preventing injury and violence. “How can we do that when the people who have spent decades of their life combating the health issues of our nation are being tossed out with no notice?”

The HHS workforce reductions decimated divisions focused on chronic disease.

Gone is most of the CDC’s population health division, which conducted research and developed public health programs on chronic disease. Gone, too, are staffers at the NIH who focused on Alzheimer’s research. After HHS staffers working on Alzheimer’s projects were put on administrative leave, the Alzheimer’s Association sounded the alarm about the cuts, saying in an April 1 statement that the reductions “could cause irreversible damage.”

And gone is the CDC’s Office on Smoking and Health which worked to protect the public from the harmful effects of tobacco use. The administration also gutted the FDA’s Center for Tobacco Products, which enforces advertising restrictions. Tobacco use is the leading preventable cause of disease, disability, and death in the country.

“Cuts to CDC and FDA tobacco control programs are devastating,” Tom Frieden, MD, MPH, who served as director of the CDC from 2009 to 2017, said April 18  on the social media platform Bluesky.

According to administration fact sheets and press releases, the staffing cuts will save $1.8 billion a year and shrink HHS’ workforce from 82,000 to 62,000 full-time employees. HHS will be retooled to focus on “safe, wholesome food, clean water, and the elimination of environmental toxins,” according to a March 27 press statement  The restructuring will improve Americans’ experience with HHS by making the agency more responsive and efficient, the statement said.

Roger Severino, a lawyer who led the HHS Office for Civil Rights during the previous Trump administration, said the job cuts are necessary because the HHS budget has grown while American health has declined.

“If you want to Make America Healthy Again, you have to make HHS healthy again. You have to trim the bureaucratic fat,” said Severino, who is now vice president of domestic policy at the Heritage Foundation, a conservative policy group. “We haven’t seen chronic disease go down or obesity go down, while autism rates are up. If this were a private company, it would have gone bankrupt years ago.”

But many public health experts question how the federal government will be able to respond to existing problems, as well as new health issues, with fewer employees and resources.

Infectious diseases are one area of concern.

Trump, on the first day of his second term in office, withdrew the nation from the World Health Organization (WHO), which detects, monitors, and responds to emerging health threats. The U.S. has been the largest financial contributor to the organization.

Without membership, the U.S. may remain in the dark if the WHO identifies an emerging threat that could ultimately spread and become global. Spillover can happen: In 2014, an Ebola outbreak in West Africa led to 11 reported cases in the U.S. The WHO played a central role in developing infection-prevention protocols and provided logistical support to affected countries.

The evisceration of the U.S. Agency for International Development could also leave the nation more vulnerable because the agency worked with countries such as Vietnam on early detection of diseases including bird flu. The agency typically would have aided in the response to a current Ebola outbreak in Uganda, providing support that doctors say helped prevent spread in past outbreaks.

The staffing reductions and frozen or canceled grants are having an immediate impact on the ability to respond to infectious outbreaks . Right now, for instance, Texas is in the throes of a measles outbreak, with more than 500 confirmed cases.

But the administration’s funding cuts forced the Dallas County health department to lay off 11 full-time workers and 10 part-time staffers responsible for responding to such outbreaks, Philip Huang, MD, MPH, director and health authority for the Dallas County Health and Human Services Department, said at a press event.

The administration has also imperiled ongoing research, including studies and trials related to chronic disease.

Trump ended hundreds of research projects at the NIH totaling more than $2 billion, including projects on HIV prevention drugs and Alzheimer’s disease research.

“Patients enrolled in NIH studies led by Plaintiffs face abrupt cancellations of treatment in which they have invested months of time with no explanation or plan for how to mitigate the harm,” according to a federal lawsuit filed in Massachusetts by scientists and researchers.

The research being cut could potentially have supported Trump’s pledge, when he honored the boy with brain cancer, to drive down rates of the disease. In the weeks since, however, Trump’s administration announced plans to weaken  automobile tailpipe emission standards. Trump slashed more than 400 grants to Columbia University, including millions earmarked for a cancer center.

“It’s making people sicker again. Now that would be a more honest bumper sticker,” said Leslie Dach, a former Obama administration official who is the executive chair of Protect Our Care, which advocates for the Affordable Care Act. “They’re stopping research on vaccines and gutting healthcare programs that keep 100 million Americans healthy. It’s all show. It’s a bunch of junk.”

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Last night I was contacted by a chronic pain pt. This pt is a chronic pain pt, but what she described to me was that she had a shattered patella.

In seeing her PCP, her BP was 220/110 and her PCP told the pt that he could not prescribe any more pain meds. He was at the “LIMIT” that he could prescribe.

The PCP called the pt’s pain clinic and that clinic was SO CONCERNED that they moved the pt’s appt UP ONE WEEK, so that made the pt’s appt at the pain clinic ONLY TWO WEEKS AWAY.

What I find interesting, both the PCP & the pain doc are EMPLOYEES OF THE SAME LARGE HOSPITAL SYSTEM.

In fact the hospital claims – on their website – to be the LARGEST HOSPITAL IN OHIO – 1,059-bed, teaching hospital , whose mission “to improve the health of those we serve.” Our caring and compassionate teams do this through providing the best patient experience possible, and  is a Level II trauma center.

This is the chart from the American Heart Assoc on the various levels of blood pressure and classification, and this pt’s blood pressure falls in the HYPERTENSIVE CRISIS LEVEL (consult your doctor immediately)

I told the pt that I would contact both of the practitioners but the pt declined.

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It is FED AG Pam Bondi who is in charge of seeing that all of our laws are enforced.  RFK Jr wants to make America Healthy Again. Yet Bondi seems to be out of step with MAHA. Can anyone be HEALTHY and have their QOL that is in the gutter and/or circling the drain?

This law has been on the books since 1935, 35 yrs before the Controlled Substances Act was signed into law.

42 USC 1395: Prohibition against any Federal interference

https://uscode.house.gov/view.xhtml?req=(title:42%20section:1395%20edition:prelim)

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Here are two inquiries and responses from Grok, which can be found within the X/Twitter website. The first was fairly factual. IMO, most of the opioid deaths were from Pharma opioids that were diverted. People would go to a “Oxy doc” and get some meds and sell half of what they got, to help pay for their half and what they had to pay to travel over several states to get to a “oxy doc’s office” to get a Rx.

Normally, I use www.perplexity.ai and I learned early on that these AI programs can be biased or use the most frequently stated information in the various media. Which should not be a surprise since a few companies own/manage a large segment of the news media. I did find out when the AI was incorrect or “off base” that I could tell it to go back out and “dig a little deeper for the truth” and they will come back and give more correct information. Now if they continue to use the new information if others ask similar questions they use that or fall back to the information that they provided me?

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The United States Files False Claims Act Complaint Against Three National Health Insurance Companies and Three Brokers Alleging Unlawful Kickbacks and Discrimination Against Disabled Americans

https://www.justice.gov/opa/pr/united-states-files-false-claims-act-complaint-against-three-national-health-insurance

The United States filed a complaint today under the False Claims Act (FCA) against three of the nation’s largest health insurance companies — Aetna Inc. and affiliates, Elevance Health Inc. (formerly known as Anthem), and Humana Inc. — and three large insurance broker organizations — eHealth, Inc. and an affiliate, GoHealth, Inc., and SelectQuote Inc. The United States alleges that from 2016 through at least 2021, the defendant insurers paid hundreds of millions of dollars in illegal kickbacks to the defendant brokers in exchange for enrollments into the insurers’ Medicare Advantage plans.

Under the Medicare Advantage (MA) Program, also known as Medicare Part C, Medicare beneficiaries may choose to enroll in health care plans (MA plans) offered by private insurance companies, such as defendants Aetna, Anthem, and Humana. Many Medicare beneficiaries rely on insurance brokers to help them choose an MA plan that best meets their individual needs. Rather than acting as unbiased stewards, the defendant brokers allegedly directed Medicare beneficiaries to the plans offered by insurers that paid brokers the most in kickbacks, regardless of the suitability of the MA plans for the beneficiaries. According to the complaint, the broker organizations incentivized their employees and agents to sell plans based on the insurers’ kickbacks, set up teams of insurance agents who could sell only those plans, and at times refused to sell MA plans of insurers who did not pay sufficient kickbacks.

The United States further alleges that Aetna and Humana each conspired with the broker defendants to discriminate against Medicare beneficiaries with disabilities whom they perceived to be less profitable. Aetna and Humana allegedly did so by threatening to withhold kickbacks to pressure brokers to enroll fewer disabled Medicare beneficiaries in their plans. The United States alleges that, in response to these financial incentives from Aetna and Humana, the defendant brokers or their agents rejected referrals of disabled beneficiaries and strategically directed disabled beneficiaries away from Aetna and Humana plans.

“Health care companies that attempt to profit from kickbacks will be held accountable,” said Deputy Assistant Attorney General Michael Granston of the Justice Department’s Civil Division. “We are committed to rooting out illegal practices by Medicare Advantage insurers and insurance brokers that undermine the interests of federal health care programs and the patients they serve.”

“It is concerning, to say the least, that Medicare beneficiaries were allegedly steered towards plans that were not necessarily in their best interest – but rather in the best interest of the health insurance companies,” said U.S. Attorney Leah B. Foley for the District of Massachusetts. “The alleged efforts to drive beneficiaries away specifically because their disabilities might make them less profitable to health insurance companies are even more unconscionable. Profit and greed over beneficiary interest is something we will continue to investigate and prosecute aggressively. This office will continue to take decisive action to protect the rights of Medicare beneficiaries and vulnerable Americans.”

The lawsuit was originally filed under the qui tam or whistleblower provisions of the FCA. Under the FCA, private parties can file an action on behalf of the United States and receive a portion of the recovery. The FCA permits the United States to intervene in and take over the action, as it has done here. If a defendant is found liable for violating the FCA, the United States may recover three times the amount of its losses plus applicable penalties.

The Justice Department’s Civil Division, Commercial Litigation Branch, Fraud Section and the U.S. Attorney’s Office for the District of Massachusetts are handling the matter, with valuable assistance from the Department of Health and Human Services (HHS) Office of Inspector General and the FBI.  The case is captioned United States ex rel. Shea v. eHealth, et al., No. 21-cv-11777.

Trial Attorneys David G. Miller, Anna H. Jugo, Diana E. Curtis, and Sara B. Hanson of the Justice Department’s Civil Division and Assistant U.S. Attorneys Charles Weinograd and Julien Mundele for the District of Massachusetts are handling the matter.

The investigation and prosecution of this matter illustrates the government’s emphasis on combating healthcare fraud.  One of the most powerful tools in this effort is the FCA.  Tips and complaints from all sources about potential fraud, waste, abuse, and mismanagement, can be reported to HHS at 800-HHS-TIPS (800-447-8477).

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