The Importance of Men’s Health Month

Posted on June 1, 2025 by Pharmaciststeve

The Importance of Men’s Health Month

https://www.lifespan.org/lifespan-living/importance-mens-health-month

At every stage of life, men are encouraged to consider three equally important aspects of their health—physical health, mental health and social connection. Men’s Health Week and Men’s Health Month raise awareness of how these aspects work together and remind men to take charge of their health.

What is Men’s Health Week?

National Men’s Health Week was established in 1994 as a special campaign to help educate men, boys and their families about the importance of positive health attitudes and preventive health practices. Today, the week is observed around the world as International Men’s Health Week and begins on the Monday before Father’s Day in June and ends on Father’s Day itself.

The aims of the week are to heighten awareness of preventable health problems for males of all ages, to support men and boys to engage in healthier lifestyle choices and to encourage the early detection and treatment of diseases like cancer, heart disease and depression.

What is Men’s Health Month?

Men’s Health Month in the United States is observed every June. This month aims to raise awareness of the same health concerns of Men’s Health Week but lasts the whole month. It is different from Movember, which is held in November and focuses on men’s mental health as well as prostate cancer. During the month of June, men are encouraged to set goals for their own health and wellness and begin to create a roadmap for achieving those goals.

The physical aspect of men’s health

Men 15-65 years of age are significantly less likely than women to seek preventive care services, and they are more likely to report not having a primary care provider. A good first step on the path toward improved health is to make a call and establish with a primary care provider (PCP). A PCP will review medical, surgical and family history and recommend age- and risk-appropriate health screenings.

Recommended screenings for young men (18-39)

Men in this age range are encouraged to discuss the health concerns below with their doctors. These discussions can be part of a yearly annual wellness visit. While you may think you don’t need some of these tests, establishing a base line can be useful for continued health monitoring as you age, or as more acute health concerns arise.

  • Physical exam: check blood pressure, screen for obesity and assess body composition (waist circumference). Testicular exam and testicular self-exam are important at this age.
  • Metabolic screening: fasting blood sugar and fasting lipid profile based on risk and family history.
  • Vaccines: influenza, COVID-19, Hepatitis A/B, HPV, Tdap and MMR should be considered.
  • STI screening: HIV, Hepatitis B/C, syphilis, gonorrhea and chlamydia screening should be considered, and pre-exposure prophylaxis for HIV (PreP) should be discussed.
  • Assessment of risky behaviors: discuss any use of tobacco, alcohol, recreational drugs, anabolic steroids, as well as use of seatbelts and helmets and gun safety.
  • Family planning: “pre-conception” counseling to educate men that adopting a healthy lifestyle—exercising, eating healthy foods, and avoiding substances—at an early age improves the chances of conceiving and having a healthy pregnancy and a healthy child.

Recommended screenings for adult men over 40

These screenings are similar to those recommended for younger men but start to look at health concerns that most often appear in middle age. 

  • Physical exam: check blood pressure, screen for obesity, measure body composition and consider prostate exam (in some cases).
  • Metabolic screening: fasting blood sugar and fasting lipid profile and estimation of cardiovascular risk.
  • Vaccines: influenza, covid-19, Hepatitis A/B, HPV (through age 45), Tdap and MMR. Shingles vaccine is recommended for adults over 50.
  • STI screening: HIV, Hepatitis B/C, syphilis, gonorrhea and chlamydia screening should be considered, and pre-exposure prophylaxis for HIV (PreP) should be discussed. 
  • Cardiovascular screening: based on risk and symptoms (may include stress testing or coronary artery calcium score).
  • Cancer screening: based on family history and personal risks. May include prostate, colon and lung cancer screening as well as skin exam.
  • Eye exam.

Recommended screenings for adult men over 65

Older men should continue to evaluate their health and make lifestyle changes based on conversations with their doctors to ensure they are able to live life to the fullest.

  • Physical exam: blood pressure, height and weight, waist circumference and prostate exam.
  • Metabolic screening: fasting blood sugar, fasting lipid profile, thyroid function (in some cases).
  • Vaccines: influenza, covid-19, Hepatitis A/B, Tdap, Pneumovax/Prevnar and Shingles.
  • STI screening: based on risk.
  • Cardiovascular screening: abdominal ultrasound, coronary artery calcium score and stress testing based on risk and symptoms.
  • Cancer screening: prostate, colon and lung as well as skin exam.
  • Osteoporosis: screening should be considered in men over 70, men who lose height over time or have a low impact fracture. Fall risk assessment should be completed.
  • Eye exam.

The American Urology Association has published a Men’s Health Checklist with a detailed description of recommended health screenings for men of all ages.

A complete list of recommended adult vaccinations is available from the Centers for Disease Control.

Men’s Mental Health

Mental health is an important determinant of overall health and quality of life at every age. Although men are more likely to suffer “deaths of despair” including alcoholism, overdose and suicide, they are far less likely than women to seek out mental health services. Undiagnosed and untreated mood disorders in young men are associated with impaired learning, risk-taking behaviors, use of substances and violence. Adult men with chronic diseases like diabetes and cardiovascular disease have worse outcomes when they also suffer from depression, and depression is associated with decreased longevity in older men.

Men should be aware of the symptoms of depression and anxiety and know when it’s time to seek help. Organizations like HeadsUpGuys, the National Black Men’s Health Network, Don’t Change Much and the Movember Foundation provide useful tips for self-care and have online self-assessment tools to help men know when it’s time to speak with a healthcare professional. Opening up about mental health and normalizing a discussion around depression, anxiety and suicide risk is something that men can do for themselves and for each other.

The Importance of Social Connection

Social connection is essential to our health and well-being, and an increasing number of Americans report loneliness and social isolation. Research shows that people who experience loneliness and isolation are at increased risk of heart disease, dementia, stroke, depression and anxiety. Lacking social connection can even increase the risk of premature death to levels comparable to smoking. On the other hand, maintaining social connection promotes better physical and mental health, eases stress and even promotes a healthier immune system. Taking simple steps like answering a phone call from a friend, inviting someone to share a meal or volunteering in your community can help you to feel connected. The US Surgeon General recently issued a first-of-its kind advisory on the epidemic of loneliness and isolation. In it, Vice Admiral Vivek H. Murthy outlines actions that we can take on a national, local and individual level to help us all stay connected.

Men’s Health Month is the perfect time to chart your course to improved health. Keep up with health screenings and listing to your body when symptoms come up. Make mental health a priority and take steps to manage stress and stay connected.

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The BIG PUSH for ADDICTS to get access to buprenorphine

Posted on June 6, 2025 by Pharmaciststeve

Engaging Community Pharmacists in Improving Treatment Outcomes for Patients with Opioid Use Disorder

https://forefdn.org/grantee-spotlight-engaging-community-pharmacists-in-improving-treatment-outcomes-for-patients-with-opioid-use-disorder/

In late 2022, Congress passed legislation allowing any DEA-registered prescriber to prescribe buprenorphine for the treatment of opioid use disorder. Only around half of U.S. pharmacies stock it, however, because of controlled substance purchasing and dispensing requirements.

Today, the National Association of Boards of Pharmacy and the National Community Pharmacists Association will begin distributing a first-of-its-kind practice guideline to the nation’s 60,000 community pharmacists. It’s part of an ambitious effort to increase access to buprenorphine, a lifesaving treatment for opioid use disorder (OUD). Studies have found fewer than 60 percent of pharmacies have the medication in stock, putting patients with OUD at risk of treatment interruptions and overdose. The Pharmacy Access to Resources and Medication for Opioid Use Disorder (PhARM-OUD) Guideline is designed to educate pharmacists about the importance of providing access to buprenorphine and help them navigate a complex set of regulatory and clinical barriers to access. FORE spoke to Tyler J. Varisco, PharmD, PhD, assistant professor at the University of Houston College of Pharmacy, who led the FORE-funded project, about how the guideline was developed and what he hopes it will accomplish. It’s been endorsed by a wide array of professional societies and advocacy organizations, including the American Society of Addiction Medicine, the American Pharmacists Association, the American Association of Psychiatric Pharmacists, the American Society of Health-System Pharmacists, and Vital Strategies.

Much of your research focuses on how the decisions pharmacists make at the pharmacy counter influence access and treatment outcomes for substance use disorders. How did you become interested in this topic?

Varisco: It started with my first job as a pharmacy technician. We had a patient on buprenorphine. She was very, very adherent to her medication but only bought three to five films at a time and paid with cash. I suspect it was because she didn’t want to her employer to know about her diagnosis. Coming to the pharmacy a couple of times a week was a major red flag for the pharmacist in charge and he eventually dismissed her as a patient. I was just told, “We’re not going to serve junkies.” As I progressed in my career, I continued to see how that stigma laden perspective interferes with access. Beginning my career at the tail end of the opioid prescribing crisis was also formative. We were ordering and dispensing large quantities of hydrocodone but triaging patients seeking buprenorphine. The contradiction spurred me to study how pharmacy-specific factors influence controlled substance supply, which revealed significant gaps in access to buprenorphine.

What stood out in your research?

Varisco: Looking at data from prescription drug monitoring programs, I was struck by how much variation there was in pharmacies dispensing buprenorphine and how much risk that posed for patients. Using data from Texas, we found the majority of physicians who prescribed buprenorphine were sending their patients to a single pharmacy. This meant patients had to travel farther to fill prescriptions. It also put patients at higher risk if there was a supply disruption because they had fewer pharmacies to turn to. My research also showed that when physicians had more pharmacies to refer to, their patients were more likely to be adherent to treatment.

Because that makes it easier to fill prescriptions?

Varisco: Yes. When it comes to a life-saving medication, having widespread and redundant sources is critical. In a subsequent study, we found that more than a quarter of patients prescribed buprenorphine will change their pharmacy within six months and that patients who changed pharmacies were about 1.67 times more likely to have a gap in therapy of seven days or longer. I don’t think many pharmacists realize how serious these short interruptions in therapy are. Within the first two weeks of a sudden interruption, the patient’s risk of mortality increases by about a factor of nine. A pharmacist may think, “Well, they’re going to be a couple of days delayed in filling their prescription.” But this is not missing a single dose of diabetes medication. This is potentially plunging that patient into withdrawal and the constellation of bad things that can occur if a patient cannot fill their prescription on time.

“For years, NABP has advocated strongly for pharmacists’ role in expanding patient access to approved medications like buprenorphine to treat OUD. NABP’s collaboration with NCPA and UH to develop a buprenorphine dispensing guideline for pharmacists was a natural convergence of our shared goal to ensure patients can access the treatment they need. NABP furthered this effort by hosting a public comment period for the draft guideline and convening an expert panel to review the comments, consider revisions, and finalize the document. NABP appreciates the opportunity to support the project and hopes this guideline will help pharmacists to fulfill their role in preventing opioid overdose deaths.”
Lemrey “Al” Carter, PharmD, MS, RPh‚ Executive Director/Secretary, National Association of Boards of Pharmacy

Why are pharmacists reluctant to stock or dispense the drug?

Varisco: There are a number of factors at play. Even at top pharmacy schools, it’s rare for pharmacists to receive extensive training about OUD or addiction, so many may be unaware of how effective buprenorphine is and the danger that delays or interruptions in treatment present. Many pharmacists are also concerned that ordering buprenorphine from pharmaceutical distributors will raise alarms about diversion and could trigger an investigation or a suspension in shipments of controlled substances. They know that distributors are obligated under the terms of opioid settlements to flag orders above a certain threshold. But under the current system for monitoring controlled substance distribution, pharmacists aren’t permitted to know the numerical value of the threshold, so some limit dispensing or they avoid ordering buprenorphine altogether.

How did you develop the guideline for such a multidimensional issue?

Varisco: It’s the result of a collaboration between the two national associations and three schools of pharmacy: mine, the University of Texas at Austin, and the University of Southern California. We started by interviewing community pharmacists to get a sense of how stigma might play into their dispensing decisions and how administrative, financial, and regulatory barriers to buprenorphine dispensing might vary by region. We convened focus groups in three states — California, Texas, West Virginia.

How much variation did you find?

Varisco: Quite a bit. In Texas, where I live, we found pharmacists have very little experience with dispensing buprenorphine because there are so few treatment providers outside of urban areas. In West Virginia, the pharmacists had more experience with buprenorphine but said they would refuse prescriptions for patients who were not in the same county, which is problematic. In California, where the state has expanded access to buprenorphine through the Medicaid program, we found many independent pharmacists were still reluctant to carry it because of the financial burden of maintaining an inventory and concerns related to distributor thresholds. We shared these and other findings with a panel of experts who helped develop and refine the final recommendations. The panel included past and present members of state pharmacy boards and community pharmacists, as well as people who worked in drug enforcement and with pharmaceutical distributors. It also included addiction medicine physicians and psychiatric pharmacists who have expertise in substance use disorder treatment.

It’s quite an extensive document, with nine main and 39 supporting recommendations. How would you summarize the main takeaways?

Varisco: First and foremost, it is critical that pharmacists treat OUD as they would any other chronic disease and recognize that lack of compassion and support for patients with the disease has deadly consequences. Many of the recommendations encourage pharmacists not to assume ill intent on the part of customers. If they have concerns about why a patient may be traveling to obtain a prescription or seeking one early, they should inquire about it rather than refusing to fill their prescription. If there is a delay in reaching a prescriber, the recommendation is to provide a one, two, or three-day supply to ensure a patient doesn’t go into withdrawal.

How do you address pharmacists’ concerns about being investigated or reaching a threshold that limits their supply?

Varisco: If they’re not rapidly expanding the quantity of buprenorphine they’re dispensing, they’re highly unlikely to hit a distributor threshold. Our guidance is that they should dispense up until they are notified that they crossed the threshold rather than attempt to guess or interpret what their threshold may be. If they do reach it, they can work with their distributor to modify that threshold to ensure that they’re able to fulfill the medical needs of their patients. All three distributors do have a process to file and modify a pharmacy threshold.

Do you have plans to engage patients themselves in ensuring access as well?

Varisco: Yes. We’re going to be working with the Behavioral Health Foundation in Tennessee and Faces and Voices of Recovery, and the O’Neill Institute to gather input from people with OUD on their experiences at pharmacies. We’ll work with a patient workgroup to develop tools that help patients advocate for themselves. We’re envisioning a patient bill of rights that focuses on explaining protections under the Americans with Disabilities Act, which we think applies to inappropriate refusals at the pharmacy counter. We also want them to create educational materials to help patients understand the dispensing process, pharmacy barriers to access, and information on what to do if a pharmacy cannot dispense their medication.

What additional supports might help patients obtain prescriptions with more ease?

Varisco: I think having knowledgeable, trained peer navigators available to go into pharmacies with patients could make a tremendous difference. Having them report on their encounters is also absolutely crucial. The American Society of Addiction Medicine has a portal on their website that allows patients to report pharmacies who refuse buprenorphine prescriptions. Having more access to tools like that and getting that information back to pharmacy organizations and boards of pharmacy can be incredibly useful here.

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When is prohibition a BAD THING & when is it a GOOD THING

Posted on June 6, 2025 by Pharmaciststeve

The Prohibition Amendment, known as the Eighteenth Amendment, was ratified on January 16, 1919, and prohibited the manufacture, sale, and transportation of intoxicating liquors in the United States.

It was later repealed by the Twenty-first Amendment on December 5, 1933.

16th Amendment and the Establishment of Modern Income Tax (1913)

Congress had established our income system in 1913, and from what I have read, since states had to ratify an amendment, Congress and the states were covering all the financial bases because they knew that there would be a loss of alcohol tax revenues due to alcohol prohibition. What they didn’t foresee was all the alcohol being smuggled in from Canada, and that everyone and their Brother had built stills to make Moonshine.

They had raised income taxes to compensate for the loss of Alcohol taxes, but apparently they just couldn’t stand all the alcohol that was still being sold and consumed, and the Feds & the States not getting any tax revenue off of it. So they repealed the 18th Amendment with the 21st Amendment 14 yrs later.

Then we have the Controlled Substances Act that was signed into law in abt 1970. The CSA created the BNDD ( Bureau of Narcotics & Dangerous Drugs), as I remember, the BNDD really did not do much, but in 1973, Congress created the DEA with 1200 employees, and they appeared to take their job seriously.  They had numerous campaigns with slogans.  “Just Say NO” was the most infamous slogan back then.

In abt 2000, Congress passed a bill, “The Decade of Pain Law,” that strongly encouraged prescribers to properly treat a pt’s chronic pain. The Joint Commission (JC) labeled this law as the “Fifth Vital Sign” and made it a major standard for hospitals to meet to maintain their JC accreditation. 

When the law expired ten years later, the political party in the majority of Congress had FLIPPED, and the law was not renewed. Opioid Rxs peaked in the 2010-2012 time frame. Florida did not have an active PDMP when the Decade Pain Law was in force. Early in the 2010 decade Rick Scott became Florida’s Governor, and Pam Bondi became attorney general.  They got the FL legislature to get a PDMP up and running in FL.

When Bondi ran for a second term, her TV ads stated that she ran over “200 oxy docs” out of Florida.

It would seem that the Tobacco lawsuit settlement that was settled in ~ 1999 gave a lot of bureaucrats and law firms the idea to start suing anyone and everyone who is involved in the opioid distribution system.

Purdue Pharma, whose Rx opioids were only 4% of all opioids, got sued into bankruptcy. From all the fines that were imposed on them by our judicial system. The advertising agency for Purdue Pharma got sued and ended up owing 350 million for helping Purdue Pharma promote the opioid products.

The pharmacy chains have had “rapid fire” lawsuits over the last 10-15 yrs. Rite Aid, which once had 5,000 stores, is now in bankruptcy and having a fire sale on the last 1,000 stores. Those stores will be bought up, and most will be closed, and those stores will be closed and the Rx files will be transferred to the buyer of those Rite Aid stores.

Walgreens, which once promoted that they were “the Pharmacy where America Shopped,” has been shedding a few hundred stores annually for a long time. A company that was once valued at 100 billion dollars is being sold off to an “investor group” for 10 billion.

The DOJ/DEA is so brazen that they are suing major companies with just ALLEGATIONS, which appear to be gathered from some “data mining” of filled opioid Rxs databases. Sort of a GUILTY UNTIL PROVEN INNOCENT.

Over the last 10-15 years, the DOJ/DEA has extracted 100 of billions of dollars out of all the companies and some practitioners that are involved with providing controlled medications to patients who have a valid medical necessity for these FDA-approved medications.

Is this an example of where prohibition has proved to be an easy source of money from entities that are providing a legal product?

Does this suggest that there is going to be a huge number of corporate corpses in the wake of this new wave of extortion of various entities that are selling a legal product to pts who have seen a prescriber who provides them a legal prescription for controlled substances?

We have seen the Feds reverse alcohol prohibition because they were failing to generate some tax revenue. Who believes that the Feds are going to ease up on the extortion and prosecution of all entities that are selling the legal product of FDA-approved controlled substances?

What other chronic health issues is “Uncle Sam” going to decide are “too expensive” for our society to manage and/or treat? Over the last 16 yrs we have seen our national debt increase FOUR FOLD ( from 9 trillion to abt 37 trillion).

U.S. Debt Credit Rating Downgraded, Only Second Time In Nation’s History

Death with Dignity laws – 11 states have laws, and 4 have it under consideration to make it the law. Have we come to the point where if you are not a “maker”, you should do what is best for our society, as a whole, to “check out”?

Oregon was the first state to pass such a law in 1989  https://deathwithdignity.org/history/

 

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This is the industry that Pres Trump is going after to lower our Rx Prices

Posted on June 4, 2025 by Pharmaciststeve

This is a single example of where the $$ goes that the pt hands over at the Rx counter. If anyone has noticed, all of sudden the PBM industry is now advertising on TV claiming how much money they are saving people.

 

When I first started working in a pharmacy back in the summer of 1968. There was no PBM industry, and 90 %+ of all prescriptions were BRAND NAME, and the average Rx price was in the $4-$5 range. The PBM industry came around at the end of 1969. Today, 85 % + of Rxs are generics, and 85 % of Rxs are paid for by PBMs. The average Rx price today is in the $70 range.  If the PBM industry had not gotten involved in the prescription business, and nothing had changed, the average Rx price would be around $40. If we just had the change of brand names to generics at the same percentages, the average Rx price would probably be in the $25-$30 range. Just imagine if we didn’t have the PBM to save us money and require prior authorizations, mandatory generic substitution, step therapy, day’s supply limitations, and numerous other things that do nothing to improve a pt’s therapy and QOL.

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Pharmacogenomics – the core of individualized precision medication therapy.

Posted on June 4, 2025 by Pharmaciststeve

Pharmacogenomics – the core of individualized, precision medication therapy.

For the pts who are having a difficult time getting their pain managed properly. Having your PGx (DNA) testing done. The test is from a simple cheek swab.  Send it off to the lab, and in a couple of weeks, you will typically get a somewhat semi-vague report.  The report that you will first get can be as much as 70 +/- pages, listing some general plus or minuses comparing your CYP-450 liver enzymes with your medications and gives you some recommendations about how your body metabolizes the medications that you take. The graphic to the right is what a medical professional will work with to help them narrow down which particular medication in a particular category will work best with your CYP-450 liver enzymes, and your body will metabolize a particular med best.

An example is that Hydrocodone has to be metabolized to its active metabolite, which is Hydromorphone. If your body poorly metabolizes Hydrocodone, you are not going to get very good pain management.

Some prescribers do not believe in this system. The MME and Narxcare do not take PGx into consideration when determining a pt’s most appropriate dose. Most insurance companies don’t want to pay for PGx testing because they don’t see how it is going to increase their bottom line. Most don’t care if it improves the pt’s QOL.

Pharmacogenomics (PGx) is the study of how a patient’s genetic makeup influences their response to medications, with the goal of personalizing therapy to maximize benefit and minimize harm. The science and clinical application of PGx have advanced rapidly, and there is now strong evidence that proper use of PGx recommendations can significantly improve patient outcomes—especially for those with complex or high-acuity health issues.

What Is Behind the PGx System and Evaluations?

  • Core Principle:
    PGx focuses on identifying genetic variations—especially in genes encoding drug-metabolizing enzymes (like CYP450 family), drug transporters, and drug targets—that affect how drugs are absorbed, metabolized, and act in the body178.

  • Testing and Interpretation:
    PGx testing analyzes a patient’s DNA for variants (polymorphisms) in key pharmacogenes. Results are interpreted using evidence-based guidelines (e.g., CPIC, DPWG) that link specific genotypes to drug dosing, efficacy, and risk of adverse drug reactions (ADRs)92312.

  • Actionable Recommendations:
    Recommendations may include dose adjustments, drug selection, or enhanced monitoring based on the patient’s genotype-predicted phenotype (e.g., poor, intermediate, normal, or ultra-rapid metabolizer)18.

Evidence for PGx Improving Patient Outcomes

  • Reduced Adverse Drug Reactions:
    Multiple large studies and systematic reviews show that PGx-guided therapy reduces clinically significant ADRs. For example, the PREPARE trial (n=6,944) found a 33% lower risk of ADRs in patients receiving genotype-guided therapy compared to standard care136.

  • Improved Efficacy:
    PGx testing helps select the right drug and dose, increasing the likelihood of therapeutic success, especially in fields like psychiatry, cardiology, and oncology81411.

  • Cost Savings:
    PGx-guided therapy can lead to substantial cost savings by reducing ineffective prescribing, ADRs, and hospitalizations. Studies report annual savings of $600–$4,000 per patient, even after accounting for test costs46.

  • Clinical Guidelines and Implementation:
    The Clinical Pharmacogenetics Implementation Consortium (CPIC) and other expert groups provide graded, evidence-based recommendations for dozens of drug-gene pairs, supporting integration into routine care932.

Who Benefits Most from PGx?

  • High-Acuity and Complex Patients:
    Patients with multiple comorbidities, polypharmacy, or a history of ADRs benefit most from PGx, as they are at higher risk for drug-gene and drug-drug interactions4510.

  • Elderly and Those with Chronic Conditions:
    PGx can be especially valuable for elderly patients and those with chronic or rare diseases, as their medication regimens are more likely to be affected by genetic variability105.

  • Patients Requiring High-Risk Medications:
    For drugs with narrow therapeutic indices or high risk of toxicity (e.g., warfarin, codeine, certain antidepressants and antipsychotics), PGx-guided prescribing can be lifesaving814.

Summary Table: PGx Benefits

Benefit Area Evidence/Outcome
ADR reduction 30–33% lower risk of ADRs in PGx-guided groups136
Improved efficacy Higher rates of therapeutic success, especially for complex regimens811
Cost savings $600–$4,000 per patient per year46
Polypharmacy management More targeted therapy, fewer drug interactions4510
High-acuity patients Greater benefit due to complexity and risk105

Conclusion

PGx recommendations, when properly implemented, are supported by robust evidence—including large randomized trials and real-world studies—for improving medication safety, efficacy, and cost-effectiveness. The more complex the patient’s health issues and medication regimen, the greater the potential benefit from PGx-guided therapy. This approach is increasingly recognized as a key component of precision medicine and is being integrated into routine clinical practice worldwide111314.

  1. https://www.pbm.va.gov/PBM/AcademicDetailingService/Documents/508/IB10-1721_PGx_Provider_IntoToPrecisionMedicine_P97138.pdf
  2. https://pmc.ncbi.nlm.nih.gov/articles/PMC10233068/
  3. https://pmc.ncbi.nlm.nih.gov/articles/PMC5117674/
  4. https://pmc.ncbi.nlm.nih.gov/articles/PMC4725634/
  5. https://pmc.ncbi.nlm.nih.gov/articles/PMC8975737/
  6. https://www.ajmc.com/view/pharmacogenomics-for-improved-outcomes-and-decreased-costs-in-health-care
  7. https://www.genome.gov/about-genomics/educational-resources/fact-sheets/pharmacogenomics
  8. https://www.ccjm.org/content/87/2/91
  9. https://cpicpgx.org/guidelines/
  10. https://www.nature.com/articles/s41397-021-00260-6
  11. https://www.news-medical.net/news/20250526/Integrating-pharmacogenomics-into-everyday-clinical-practice-can-transform-patient-care.aspx
  12. https://www.frontiersin.org/journals/pharmacology/articles/10.3389/fphar.2023.1189976/full
  13. https://www.nature.com/articles/s41397-024-00326-1
  14. https://www.bps.ac.uk/getmedia/b43a3dca-1bbf-4bff-9379-20bef9349a8c/Personalised-prescribing-full-report.pdf.aspx
  15. https://www.genomicseducation.hee.nhs.uk/genotes/knowledge-hub/introduction-to-pharmacogenomics/
  16. https://pmc.ncbi.nlm.nih.gov/articles/PMC7696803/
  17. https://www.nature.com/articles/s41576-022-00572-8
  18. https://ascpt.onlinelibrary.wiley.com/doi/10.1002/cpt.3704
  19. https://pmc.ncbi.nlm.nih.gov/articles/PMC3351041/
  20. https://www.mayo.edu/research/centers-programs/center-individualized-medicine/patient-care/pharmacogenomics/patients
  21. https://www.jax.org/education-and-learning/clinical-and-continuing-education/clinical-topics/genetic-testing/pharmacogenomic-communication
  22. https://pmc.ncbi.nlm.nih.gov/articles/PMC3299179/
  23. https://pmc.ncbi.nlm.nih.gov/articles/PMC6789586/
  24. https://guidelines.carelonmedicalbenefitsmanagement.com/pharmacogenomic-testing-2024-10-20-updated-2025-04-01/
  25. https://www.medben.com/pharmacogenomics-spend-outcomes/
  26. https://pmc.ncbi.nlm.nih.gov/articles/PMC7868558/
  27. https://www.pharmacytimes.com/view/pharmacogenomics-the-vanguard-of-precision-medicine
  28. https://pubmed.ncbi.nlm.nih.gov/40399951/

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Why is the MT Medical Board determined to deny many intractable chronic pain pts their necessary medication?

Posted on June 2, 2025 by Pharmaciststeve

The Montana Medical Board has been chasing Mark Ibsen for nearly 10 yrs. Their first attempt was a complaint from a Chiropractor who worked in Mark’s “doc in a box” practice. The AG of Montana at the time, I got the impression that he would have been happy if Montana were a “opioid desert”. I am told that the Chiropractor filed a complaint with the board that he was prescribing too many opioids. Many other practices were being raided and shut down, and Mark was trying to help those pts, who had been thrown to the curb. He was trying to lower or wean their doses down, but he found that ~ 20% were ultra-fast metabolizers. Mark spent a lot on legal fees and kept pushing the medical board back. The Medical Board’s aggressive posture cost Mark so much in legal fees that he ended up closing his practice.

A couple of years ago, Mark decided to provide pain management to what he called “opioid refugees”. Using the rules that the DEA created during the COVID-19 pandemic, virtual office visits would be permitted, and prescribers could prescribe controlled medications under those guidelines.

Now the Medical Board has an attorney – probably the State AG to call for a Grand Jury to investigate Mark. The date of this Grand Jury is July 23, 2025. Of course, it is claimed that a Grand Jury could indict a “ham sandwich”. That may be because a Grand Jury is just a judge, a jury, and the prosecuting attorney. 

IMO, if this Grand Jury finds “probable cause” that Mark is violating some law by treating these “opioid refuges “, and pulls his medical license. It will be a “death sentence” to all the intractable chronic pain pts that Mark has been trying to manage their intractable chronic pain pts and optimize their QOL.

How many patients will die from being thrown into cold turkey withdrawal, or commit suicide? It is anyone’s guess. But the primary function of all medical boards is to protect the public’s health & safety. Unfortunately, no one is involved in how this all shakes out, will not have any culpability for the adverse outcomes of their decisions.

A grand jury is a legal body primarily responsible for determining whether there is probable cause to believe that a crime has been committed and whether criminal charges should be brought against a suspect167. It serves two main functions: investigatory and accusatory (charging)125.

Investigatory Function

  • The grand jury can investigate potential criminal conduct by subpoenaing documents and witnesses, reviewing evidence, and hearing sworn testimony25.

  • This investigatory power allows the grand jury to gather information independently of the prosecution, although in practice, the process is usually guided by the prosecutor25.

Accusatory (Charging) Function

  • After reviewing the evidence, the grand jury decides whether there is enough evidence (probable cause) to formally charge a person with a crime. This formal charge is called an indictment13567.

  • If the grand jury finds insufficient evidence, it can issue a “no-bill,” and no charges are brought15.

Additional Features

  • Grand jury proceedings are conducted in secret to encourage witness cooperation, protect the reputation of individuals not indicted, and allow jurors to deliberate without outside influence357.

  • The grand jury does not determine guilt or innocence; it only decides whether there is enough evidence to proceed to trial2710.

  • In the U.S. federal system, a grand jury typically consists of 16 to 23 members, and an indictment requires the agreement of at least 12 jurors56.

  • The grand jury acts as both a “shield” against unfounded or oppressive prosecutions and a “sword” to bring charges where warranted25.

In summary, the grand jury’s function is to review evidence presented by the prosecution, investigate as necessary, and decide whether there is probable cause to formally accuse someone of a crime, thereby protecting citizens from unwarranted criminal charges while enabling legitimate prosecutions to move forward12567.

  1. https://www.justice.gov/jm/jm-9-11000-grand-jury
  2. https://www.mololamken.com/knowledge-What-Exactly-Is-a-Grand-Jury
  3. https://www.findlaw.com/criminal/criminal-procedure/how-does-a-grand-jury-work.html
  4. https://www.santacruzcountyca.gov/grndjury/gjfunction.htm
  5. https://en.wikipedia.org/wiki/Grand_jury
  6. https://www.uscourts.gov/court-programs/jury-service/types-juries
  7. https://www.nyjuror.gov/pdfs/hb_grand.pdf
  8. https://courts.ca.gov/courts/jury-service/civil-grand-jury
  9. https://www.tdcaa.com/journal/grand-jury-where-the-community-meets-the-law/
  10. https://miamisao.com/wp-content/uploads/2020/12/Florida-Grand-Jury-Handbook.pdf

TO OUR FRIENDS AND FOLLOWERS:
WITH LETTER WRITING – CALLING – EMAILING – TEXTING
AND POSTING (The Montana Board monitors Dr Ibsen’s FB page)
… many of us participated in KILLER-OUTREACH resulting in
Mark’s “case” with the MT Board of Medical Examiners being
DISMISSED February 21, 2025.
Please consider being a part of this latest effort as Mark has been summoned (subpoenaed) to appear at a Grand Jury July 23, 2025.
I request that anyone willing to volunteer being a “PATHFINDER”
send me your names + phones – to shedancedwithowls@gmail
Pathfinders will take on locating 10 others who will coordinate together their OUTREACH efforts. Outreach is most impactful when it occurs more than once from an individual – so officials see that you are not a one-off.
IF you do not want to be a Pathfinder, then as an individual sending me your telephone – will have you be in a group that will get OUTREACH ideas sent to you.
For this campaign – it is essential that your OUTREACH be about Dr. Ibsen and the physician/patient relationship you have with him. OR if you are not his patient – then what you have learned about his efforts.
Please do not message me on FB; I am not reliably checking those. I am asking all of us to take our energy which we have put into postings and instead take what you would have posted and turn it into OUTREACH to an official – media – medical board – or other.

Filed under: General Problems | 9 Comments »

Rite Aid offloads more than 1,000 pharmacies to former rivals

Posted on May 31, 2025 by Pharmaciststeve

At one time, Rite Aid had abt 5,000 stores, and soon they will be down to ZERO! Walgreens 10-15yrs ago was worth 100 billion dollars, and now there are rumors that they are selling the entire chain to a private equity firm. Years ago Walgreens had ~ 11,000 stores, and now they are down to abt 8500 stores. Typically, these private equity firms buy distressed companies, and they start selling off parts that are not as profitable as they would like or should be. They will cut the operating cost overhead to the bare bones and sell what is left for 2-3 times what they paid for the chain.

Most likely, whoever buys the Rite Aid stores will close them, and move the Rx files to one of their nearby stores, and close the Rite Aid stores.  In two or three years, we will probably see similar things happening to what is left of the Walgreens chain.

How many more pharmacy deserts will be created by all this “consolidation”?

Arkansas has passed a new law that prohibits PBM from owning pharmacies. CVS which owns the largest PBM Caremark, is threatening to close 23 stores they have in Arkansas.

Pres Trump is going after our Rx meds so that our Rx meds are the lowest prices sold to any nation on the planet. The term for this is “favored nation status”.

We have so many middlemen within our healthcare system that a lot of other countries don’t have. Since the 5 largest PBM are owned by the 5 largest insurance companies. This is going to be one hell of a legal battle between TWO GOLIATHS.

Rite Aid offloads more than 1,000 pharmacies to former rivals

The pharmacy chain is undergoing a bankruptcy process to sell “substantially all of its assets.”

https://www.retailbrew.com/stories/2025/05/19/rite-aid-offloads-more-than-1-000-pharmacies-to-former-rivals

After filing for bankruptcy earlier this month for the second time in less than two years, Rite Aid Corporation is offloading more than 1,000 pharmacies to rivals such as CVS and Walgreens as well as grocery chains such as Albertsons and Kroger.

In a press release, Rite Aid CEO Matt Schroeder said that the goal of transactions is to ensure continuity of care during the bankruptcy process; the company emphasized that all pharmacies will remain open through the transition to provide prescription refills and immunizations without interruption. 

“These agreements ensure our pharmacy customers will experience a smooth transition while preserving jobs for some of our valued team members,” he said.

Warm welcomes: On the receiving end of the deal, Albertsons is giving Rite Aid customers a warm welcome—as well as a coupon. New customers are set to receive a “$15 off” coupon for their next grocery purchase, plus another coupon for every five subsequent prescriptions.

“As a community health partner, our dedicated pharmacists are committed to providing our customers with timely, safe and convenient access to medications and essential vaccines,” Anthony DalPonte, president of pharmacy and health at Albertsons, said in a statement.

CVS similarly promised it was working toward a “seamless” transition for Rite Aid customers in a blog post.

The US Bankruptcy Court will hold a hearing on Wednesday to approve the sales.

All or nothing: While Rite Aid’s first bankruptcy in 2023 aimed to optimize the chain’s footprint and restructure its debt, the Chapter 11 bankruptcy initiated on May 5 will help facilitate the sale of “substantially all of its assets.” Anything not sold during this process, per bankruptcy steward Kroll, will no longer be owned or operated by Rite Aid.

The bankruptcy comes as a difficult time for the pharmacy business. Earlier this spring, private equity firm Sycamore Partners took Walgreens private in a $23.7 billion after a rocky run on public markets.

Filed under: General Problems | Leave a Comment »

LMAO 05312025

Posted on May 31, 2025 by Pharmaciststeve

Filed under: General Problems | 2 Comments »

Walgreens to Pay $300 Million in Unlawful Opioid Prescriptions Settlement

Posted on May 30, 2025 by Pharmaciststeve

This is another situation with the DOJ making ALLEGATIONS, and the settlement amount is based on Walgreens’ ability to pay. Maybe because all these ALLEGATIONS and settlements with DOJ and the PBMs’ low-balling reimbursements, Walgreens is most likely on the verge of declaring bankruptcy. 10-15 yrs ago Walgreens’ stock was worth ~100 billion, but they are in talks to sell the company to Sycamore Partners, a private equity firm, for ~ 10 billion.

The SCOTUS ruled in July 2024 https://www.pharmaciststeve.com/is-the-overturning-of-the-chevron-doctrine-a-good-or-bad-thing/    that federal agencies cannot create new interpretations of laws they are in charge of enforcing. It is also illegal for people/pts to obtain controlled substances under false pretenses, but there is nothing in this article of any of these people, who DOJ stated had illegal Rxs filled, being charged? What about all those illegal prescriptions? Walgreens didn’t fill them; their employee pharmacists filled them. I can’t count the number of pts that have told me that a chain pharmacist refused to fill a controlled med Rxs, and they filed a complaint with the chain HQ and were told, “We can’t force a Pharmacist to fill a Rx.”

Here is what perplexity.ai says about an allegation vs filing charges against someone/company. Maybe that is because it is a known fact that 90 – 95 %+ of people/companies taken to federal court will be found GUILTY! 

An allegation by the Department of Justice (DOJ) that a company has violated a law is not the same as formally charging the company with violating that law.

An allegation is an assertion or claim that a company has engaged in illegal conduct. It is essentially an accusation, which may be made during the course of an investigation or in public statements, but it does not in itself initiate formal legal proceedings against the company

. The DOJ may make such allegations as part of a civil investigation, in a press release, or in correspondence with the company.

A charge, on the other hand, is a formal legal action. In the context of criminal law, this typically involves the filing of an indictment, information, or criminal complaint, which are official documents that initiate a criminal case and set out the specific laws the company is accused of violating

. Only after such a document is filed does the company face formal criminal prosecution. For civil matters, a charge may take the form of a lawsuit or civil complaint.

The process generally works as follows:

  • The DOJ (or another law enforcement agency) investigates and may make allegations based on evidence gathered.

  • If the DOJ believes there is sufficient evidence, it may proceed to formally charge the company, which involves filing official documents in court

In summary, an allegation is a claim or accusation, while a charge is a formal step in the legal process that brings the accused company into court to answer the alleged violation

Walgreens to Pay $300 Million in Unlawful Opioid Prescriptions Settlement

https://jamanetwork.com/journals/jama/fullarticle/2834868

Walgreens has agreed to pay the US government $300 million in a settlement of allegations that the pharmacy chain illegally filled millions of invalid prescriptions for opioids and other controlled substances, the Department of Justice (DOJ) announced.

The civil lawsuit against Walgreens and its subsidiaries, filed in January, alleges that the drugstore chain violated the Controlled Substances Act and False Claims Act by accepting invalid prescriptions and seeking payment for them from federal health care programs including Medicare. According to the complaint, pharmacists allegedly dispensed prescriptions despite “clear red flags”—including opioid prescriptions filled significantly early, in large quantities, and in regularly abused combinations—and faced pressure from the company to fill prescriptions quickly without taking time to ensure legality.

The settlement amount is based on Walgreens’ ability to pay, the DOJ stated. If the company is sold, merged, or transferred prior to 2032, it will owe the US an additional $50 million. On top of the monetary payments, Walgreens has entered into agreements with the Drug Enforcement Administration and the Department of Health and Human Services Office of Inspector General to ensure future compliance with laws regulating the distribution of controlled substances.

A similar lawsuit against pharmacy giant CVS is still pending.

Filed under: General Problems | 4 Comments »

What Medicaid Cuts Mean for Chronic Pain

Posted on May 29, 2025 by Pharmaciststeve

What Medicaid Cuts Mean for Chronic Pain

Untreated childhood pain follows to adulthood

https://www.medpagetoday.com/opinion/second-opinions/115803

As pediatric pain psychologists, we often wish we had a magic wand that could wave away the suffering that children and their families bring into our offices. However, we know that good pain management for kids isn’t magic. It’s science. And it depends first and foremost on access to consistent, high-quality healthcare.

People are often shocked to learn that they have probably known a child with chronic pain. In fact, one in five children and adolescentsopens in a new tab or window suffer with chronic pain during their youth, making chronic pain one of the most common and overlooked disorders in childhood. Yet, for these millions of children with recurring pain, there are less than 60 pediatric pain centersopens in a new tab or window in the U.S. Pain scientists and clinicians have worked tirelessly to build these truly lifesaving programs. Still, even with years of effort, the scale of need so vastly outweighs the available resources that most families will never gain access. And now, proposed cuts to Medicaid threaten to make the situation even worse.

We meet the families that are lucky enough to access care in clinic every day. Children often arrive to their first appointments with limited physical functioning and must relearn how to move their bodies. Some show up with mobility devices and a goal of walking without assistance; others are striving to re-learn how to socially function, regulate pain-related fear, or just develop habits that help their bodies learn to sleep well at night again. Pain science has made all of these goals realistic for the majority of kids who can access good care.

Without Medicaid support, however, many children will continue to have limited functioning and difficulty returning to their lives. For the fortunate families who are able to access pediatric pain treatment centers, the results are often observed by parents to be miraculous.

For example, consider a 16-year-old female athlete who arrived at her first appointment in a wheelchair. She had difficulty getting out of bed and walking independently. She described her pain as unbearable — a feather touch to the skin yielding fiery discomfort. She had missed more school than she had attended over the past year. Her parents had to shift job schedules to take care of her. Basketball team texts became MyChart appointment reminders. The family’s whole life was engineered to fit the agenda of pain. Fortunately for this family, they were able to access an interdisciplinary team of trained pain specialists, including pain medicine physicians, pain psychologists, physical therapists, and occupational therapists. As a team, these providers were able to offer evidence-based treatment to help this athlete return to the classroom, to her sports, to her friends, and ultimately, to herself. The family could rebuild their life after 6 months of pain rehabilitation.

This is just one example of the many children we see whose lives have been twisted beyond recognition because of a chronic pain syndrome. For the family mentioned above, they were able to receive early intervention and make steady progress. However, this is not the case for families who get access to the right care too late, or never get access at all. When patients do not receive early intervention, they can develop severe chronic pain. Treatment becomes a slow and arduous march, sometimes taking months to years of therapies before a child and their family can recover functioning. It is our collected decades of experience working in the trenches with these children and families that drives our plea to ensure pediatric pain treatment is not luxury care. It is evidence based, life-altering recovery.

Children’s lives and futures are at risk right now. Without Medicaid, children will lose access to treatments like ours that quite literally give them their lives back. The proposed federal budget cutsopens in a new tab or window to Medicaid will deepen the gap between what kids need and what families can access. If we allow that to happen, we aren’t just ignoring suffering — we’re ensuring it.

Here’s the rub: ensuring childhood pain isn’t only about kids; it ensures another generation of adults with serious pain conditions. That is a reality we are intimately familiar with in this country. Childhood pain that goes untreated or undertreated is one of the strongest predictors of chronic pain in adulthood. We’ve lived through one opioid epidemic — one born in part from our failure to offer strong, early solutions for pain. If we cut off access now, we’re not just abandoning children in pain — we may be setting the stage for some version of an Opioid Epidemic 2.0. And with it, an even larger burden on our future workforce, healthcare system, and economy.

To be sure, children with private insurance will still have access to high-quality pain care, but Medicaid is the backbone of all pediatric healthcare in the U.S., covering nearly half of all childrenopens in a new tab or window. Approximately 37 million childrenopens in a new tab or window in the U.S. are enrolled in Medicaid or the Children’s Health Insurance Program (CHIP), and Medicaid accounts for more than $4 billionopens in a new tab or window in pediatric pain-related healthcare per year. In many pediatric pain programs, Medicaid is the most common payor. While Medicaid is administered through the individual states, federal funding matches at least 50%opens in a new tab or window of what states contribute. Without federal funds, fewer children will have access to pain care; though their symptoms will remain, and likely amplify over time.

We are asking you to please call your legislators. Urge them to protect Medicaid funding and remove cuts. Pediatric pain care isn’t optional. For the children and families we serve — some of whom may also be your patients, or perhaps even your children, grandchildren, nieces, nephews, and neighbors, and the youth who will one day be charged with carrying forward our society — it’s essential, life-changing care.

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