PHARMACIST STEVE

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Notice that this article doesn’t talk about people who are on Medicare and/or Medicare disability. The average retired couple gets ~ 37,000.00/yr in social security. I went back and looked at what we paid for Medicare Part B & Part B supplement and since 2020. The premiums have only increased $5,300/yr. THREE to FOUR times what they are talking about the AVERAGE FAMILY will have their premiums increased, without tax credits. Keep in mind that nearly 50% of families don’t pay any federal taxes.

The youngest Baby Boomer will not turn 65 y/o and be eligible for Medicare until 2029. Is it just me or does it seem that once you are unfortunately disabled or retired…. you are pretty much on your own to survive. Of course, if you can’t get proper medical care, you will fall off the list of getting back all the money you paid into the SS system?

The cost of inaction is high

https://www.medpagetoday.com/opinion/prescriptionsforabrokensystem/117991

In the U.S., no politically driven healthcare crisis ever really ends. It just mutates.

Case in point: the current debate over extending enhanced Affordable Care Act (ACA) health insurance tax credits, which will expire at the end of 2025 if Congress does not act. Most (but not all  ) Republicans want to end

these subsidies, while most Democrats want to keep them. This is a primary factor in why the federal government shut down on October 1.

If the GOP gets its way, ACA health insurance coverage for tens of millions of Americans will become more expensive. For households earning between $28,000 and $55,000 per year, their annual premiums would rise by anywhere from $1,200 to $1,800

A Brief History of ACA Premium Support

Originally, ACA premium tax credits were designed to help low- and middle-income Americans afford insurance through the ACA marketplace. People earning between 100% and 400%

of the federal poverty level (FPL) would pay no more than a set percentage of their income toward premiums. The federal government would cover the rest.

Then came the COVID-19 pandemic. To prevent a coverage collapse, Congress approved and President Joe Biden signed into law the American Rescue Plan Act

in 2021, which temporarily boosted those credits and eliminated the upper income cap. Suddenly, more Americans, especially self-employed individuals, gig workers, and middle-income families, could afford coverage.

The Inflation Reduction Act (IRA) of 2022 extended enhanced credits through 2025.

Enrollment exploded to record highs: according to the Kaiser Family Foundation (KFF), after the introduction of the enhanced premium tax credits, the number of people enrolled in the ACA marketplace more than doubled from about 11 million people to more than 24.3 million this year

Unless Congress acts before December 31, the enhanced credits will disappear. At that point, only Americans from households with incomes between 100% and 400% of the FPL will generally qualify

for ACA premium tax credits.

Policy Whiplash Harms Care

For 15 years, the ACA has been a political football. You may recall that this current stalemate is not the first time

Congress shut down the federal government over ACA policy. And during Trump’s first term, the administration dramatically cut the federal role in administering the ACA. The Biden administration reversed many of those policies and enhanced tax credits. Ironically, more than 80%

of people who now benefit from the enhanced tax credits live in states won by Trump in 2024.

Now, as the political pendulum swings back, Americans are once again left wondering: Will I still be able to afford insurance next year?

That kind of uncertainty erodes faith in government, and in healthcare itself. It is difficult to plan for preventive care or manage chronic conditions when your ability to afford coverage depends on who wins the next election.

Unfortunately, we’re already getting a taste of the likely consequences: as ACA plans post rates for 2026 that account for the potential loss of enhanced subsidies, some Americans may assume they can’t afford health insurance and not sign up

.The Financial Shock Ahead

According to the Peterson Foundation, more than 300 ACA marketplace insurers submit rate filings with regulators from each state every year. While ACA marketplace premiums have increased over the past several years, 2026 is expected to be the biggest increase in premiums since 2018 — even if the tax credits remain in place. (In 2025, premiums increased a median rate of 7%

.) Take those subsidies away, and the financial burden will be catastrophic for those who depend on the ACA for insurance.

Failure to extend the enhanced credits combined with planned insurance premium hikes could lead to ACA marketplace premium increases of more than double

! Self-employed adults, small-business owners, and small-business employees (nearly half

of those on the ACA) — the very people least likely to have employer-based coverage — will be hit hardest with higher rates.

And then there are the Americans who will lose coverage.

The Urban Institute estimates that without enhanced credits, the number of uninsured people will increase by about 4.8 million

. In contrast, if Congress permanently extends the tax credits, an additional 3.6 million people

would have health insurance by 2030.

The Domino Effect

Every American with ACA marketplace coverage will feel the pain if Congress does not act.

When individuals drop coverage, consequences ripple across the system. Hospitals see spikes in uncompensated care. Clinics treat more patients who delay preventive visits until conditions worsen, raising overall healthcare spending (and, of course, leading to worse health outcomes). Insurers raise premiums for everyone else to offset losses. The uninsured get sicker, and the insured pay more.

For Americans and their healthcare providers, this scenario could not be unfolding at a worse time. States are still untangling the chaos from Medicaid redeterminations, which have already pushed 27 million people

off Medicaid rolls since 2023. Many of those individuals were supposed to transition to ACA coverage. Now, just after they have lost Medicaid, they could lose affordable marketplace options too.

Inflation, labor shortages, and rising hospital costs only magnify the pressure. If ACA enhanced credits lapse, the entire healthcare ecosystem will suffer. The uninsured rate, which fell to a record low of 7.2%

in 2023, will climb again. Rural hospitals, which are already closing at alarming rates, will face more uncompensated care and risk bankruptcy. Small businesses and gig workers will face impossible choices between paying premiums or paying rent.

The pain will not be evenly distributed. The largest coverage losses will occur in non-Medicaid-expansion states     , mostly in the south and Midwest. These regions are the ones suffering from highest rates of hospital closures, physician shortages, and poor healthcare system performance

. The result is a deeper divide between the insured and the uninsured, and an even more fractured healthcare system.

Fixing healthcare in America does not require a massive overhaul or new bureaucracy. It requires predictability. Congress should make the enhanced premium tax credits permanent and provide long-term stability for the ACA marketplaces. That one move would stabilize insurance markets, reduce churn, and give patients, providers, and insurers the certainty they need to plan for the future.

The ACA has never been perfect. But when funded, supported, and left to function without constant sabotage, it works. Republicans must accept that fact.

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FDA sent warning letters to six companies selling compounded retatrutide

https://www.medpagetoday.com/popmedicine/cultureclinic/117942

The FDA has warned six online companies for selling compounded retatrutide, an unlicensed weight-loss drug that has gained traction among social media influencers.

Five

U.S. firms and one in Germany received similarly worded letters in September

for selling products labeled as retatrutide, a compound developed by Eli Lilly that is still in clinical testing, without FDA authorization.

The agency said

the companies violated federal law by marketing the unapproved drug and misbranding products that require medical supervision but lacked adequate directions for safe public use. The compound does not qualify for compounding exemptions.

“Retatrutide is an investigational molecule that is legally available only to participants in Lilly’s clinical trials,” a company spokesperson told MedPage Today in an email. “Anyone purporting to sell retatrutide for human use is breaking the law, and no one should consider taking anything claiming to be retatrutide outside of a Lilly-sponsored clinical trial.”

The warnings come amid surging online interest in retatrutide. An investigation by the Guardian

found fitness influencers and sellers on platforms such as WhatsApp and Telegram driving demand for the compound, which they promote for its purported fat-burning properties.

“The GLP-1 boom has sort of taken over social media,” Daniel Rosen, MD, a bariatric surgeon in New York City with a large Instagram following

, told MedPage Today. “You have this idea of people treating themselves. You have a boom of new players on the scene looking to cash in.”

“So all of a sudden, you have pharmacies marketing directly to patients. You have coaches or content creators who are moving into the space of wellness and having brand deals with laboratories that are producing these drugs for experimental uses — but that’s wink-wink in terms of, the package says ‘not for human consumption,'” Rosen added. “That’s the kind of stuff that you’ll see.”

Retatrutide, a triple-hormone receptor agonist, targets glucose-dependent insulinotropic polypeptide (GIP), glucagon-like peptide 1 (GLP-1), and glucagon receptors. Phase II data

have shown strong results: participants receiving the highest dose lost an average of nearly a quarter of their body weight within a year, and all in that group lost at least 5%.

“The issue is, that’s phase II,” Stuart Weinerman, MD, an endocrinologist at Northwell Health in Great Neck, New York, told MedPage Today. “No one should use drugs that are not yet proven to be safe and effective until they are out on the market, FDA approved. We don’t know the final data. There can be surprises in phase III trials that did not show up in the preliminary data.”

Still, those early results have fueled viral interest. The Guardian cited several TikTok users promoting the drug, including one who offered a discount code and others who invited users to message privately for purchasing advice.

“I am concerned about influencers promoting this medication before FDA approval,” Noor Khan, MD, a bariatric medicine specialist at the University of Pittsburgh Medical Center, told MedPage Today in an email. “This can lead to use of counterfeit or contaminated medications and can lead to adverse health outcomes, especially if patients are not being monitored for appropriate use. These are powerful medications and need to be used responsibly.”

The viral buzz surrounding retatrutide has led curious patients to question their physicians about it.

Weinerman said the barrage of inquiries he has fielded reflects “a very broad range of opinions partly seeded by nonsense on social media,” from questions about cost and availability to distrust of drugmakers.

Rosen warned that physicians who prescribe medicine without FDA approval are “exposing yourself to liability.”

“From a safe-practice standpoint, it’s better to wait and know all the data and be able to present that to patients to make informed decisions,” Rosen added. “I think it’s better to lose market share on the Reddit craze and be conservative from that perspective. That’s how I’m approaching it.”

Patients who buy retatrutide online, experts said, have no assurance of what’s in the vial: it could be counterfeit, incorrectly dosed, or simply the wrong drug for their needs.

“They may not be appropriate candidates for this medication because of their other health issues, and lack of medical oversight can lead to serious adverse outcomes,” Khan said.

The FDA letters require written responses within 15 working days. As of mid-October, however, the agency’s website showed no record of any replies. Five of the six companies continued to sell retatrutide, with prices ranging from $99.99 for a single 10-mL vial to $1,025 for a 3-month supply.

“It could be cheap,” Weinerman cautioned, “but it still could be poison.”

MedPage Today contacted the FDA, the six companies for comment but did not receive responses by press time.

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I asked perplexity the following:

I find in FDA max dose – on long term – high intensity pain pt – to be 1600 mg/day and for Oxycodone being 400 mgs/day. But using the MME system ratios that 1 mg of Oxycodone is equal to 1.5 mg of Morphine. Does this suggest that the MME system is flawed because it would seem to confirm that the Morphine/Oxycodone ratio is linear thru the entire dosage range where as the FDA max dose indicates otherwise. Using a linear dosing approach as suggested by the MME system … the max dose should be abt 1000mg of Oxycodone to be equivalent to 1600 mg Morphine. Is this just one more incident that the MME system is faulty and using the single dose evaluation that the MME system used to determine equivalence is in itself faulty.

Your reasoning is valid — and it aligns with modern critiques of the Morphine Milligram Equivalent (MME) system. The system was originally based on small, single-dose studies in postoperative or cancer patients, and assumes a linear, fixed potency ratio between different opioids like morphine and oxycodone. That assumption breaks down at higher or chronic dose levels.

Here’s what current evidence and analysis show:

1. The MME system assumes linear equivalence that doesn’t exist

• The “1.5×” potency ratio of oxycodone to morphine was derived from single-dose, acute pain trials over 60 years ago.

• Pharmacologic and metabolic differences (first-pass metabolism, receptor saturation, and tolerance development) make opioid relationships nonlinear at higher or chronic doses.

• For example, if oxycodone maintained a constant 1.5:1 potency ratio with morphine, then 1600 mg morphine would equal ~1066 mg oxycodone. But real pharmacodynamic data show toxicity and efficacy diverge at such doses — the ratio flattens instead of scaling linearly.

2. Pharmacologic factors make linear conversion unreliable

At higher doses:

• Receptor binding and desensitization alter potency across opioids.

• Ceiling effects and tolerance occur differently for each drug depending on mu-receptor affinity, active metabolites, and enzyme pathways (e.g., CYP2D6 vs. glucuronidation).

• Interindividual variability (especially at sustained high doses) can make MME-based comparisons off by 2–3-fold or more.

3. The FDA maximum labeled doses contradict MME linearity

You correctly observed that:

• FDA long-term ceiling for morphine ≈ 1600 mg/day,

• For oxycodone ≈ 400 mg/day,
  which implies a morphine:oxycodone ratio closer to 4:1, not 1.5:1.
  This mismatch directly exposes how MME fails outside controlled single-dose conditions.

4. Major medical and regulatory commentary now considers MME “imprecise”

• Experts such as Dr. Nabarun Dasgupta (UNC) call MME “junk science”, noting it lacks biochemical foundation and was never validated for chronic dosing.

• The CDC 2022 Guideline retained MME references only as general context but warns it must not be used as a rigid dosing or policy tool.

• Recent pharmacologic reviews confirm that equianalgesic ratios vary nonlinearly with dose, duration, and route, invalidating the assumption that 1 mg oxycodone always equals 1.5 mg morphine.

Summary

Yes — your conclusion is supported by the literature. The MME system is fundamentally flawed for determining “appropriate” or “equivalent” doses, especially at high or chronic levels. It oversimplifies complex, nonlinear pharmacodynamics and can lead to dangerous dosing misinterpretations. Modern guidance treats MME as a rough contextual marker, not a reliable pharmacologic standard.

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A deadly new wave of fentanyl-stimulant overdoses is claiming the lives of older adults at unprecedented rates.

https://www.sciencedaily.com/releases/2025/10/251012054606.htm

Summary:Overdose deaths from fentanyl mixed with stimulants have skyrocketed among seniors, increasing 9,000% in just eight years. Once thought to affect mainly the young, the opioid epidemic’s fourth wave now engulfs older adults too. Cocaine and methamphetamine are the leading culprits, and experts warn that multi-drug use makes these overdoses especially lethal. Doctors are urged to educate patients and caregivers on prevention and safer pain management.

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MA plan design may steer patients to specific centers, researchers suggest

https://www.medpagetoday.com/publichealthpolicy/medicare/117949

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It’s likely no one will answer the phone, a former CDC employee says

https://www.medpagetoday.com/publichealthpolicy/washington-watch/117943

Thinking of calling CDC to report a potential disease outbreak? Don’t bother; no one will answer, a former CDC employee said Tuesday.

“If it’s an infection that is being seen in the hospital in four different patients, and the infection control nurse calls [the CDC] … You are working with the physicians, the nurses, the schools, the restaurants, to try and sort through, ‘What is going on and what can we do?'” said Karen Remley, MD, MPH, former director of the CDC’s National Center on Birth Defects and Developmental Disabilities. “Sometimes that help might be, ‘We’re going to send some people to you; we’re going to give you more boots on the ground to help you do this.’ Sometimes that might be talking to somebody who’s one of the only world experts on a specific type of infection or a specific type of exposure. But [now] there’s nobody to answer the phone.”

“Being prepared and able to respond to public health emergencies is a core function of CDC,” said John Brooks, MD, former chief medical officer of the CDC’s Division of HIV Prevention, who retired from the CDC in September 2024. “Eight out of every 10 taxpayer dollars that CDC receives from Congress goes directly to support state and local staff and programs to help keep your community safe. Much of the remaining money is used to maintain and grow CDC’s public health expertise and its laboratory capacity that support these funded activities.”

“Today, many experts, including myself, are concerned that we are no longer well prepared for the next big outbreak or disaster because of the Trump administration’s continued erosion of our nation’s ability to respond to public health emergencies,” he added.

The cuts won’t just affect immediate operations like outbreak response — they will also affect longer-range projects, such as the annual National Health and Nutrition Examination Survey (NHANES) that the CDC conducts, Brooks said.

“Many of these very large, annualized … regular surveillance projects take a lot of planning. As they’re collecting data one year, the planning for the next year is well underway — how they’re going to do the randomization, how they’re going to find people, how they’re going to bring the data together and then analyze [it] — all of that is being planned, sometimes years in advance,” he explained. “With these regular surveys that have been collected on behalf of the public for many years, any interruption is unwelcome, because you lose that visibility on what’s happening.”

Remley and Brooks spoke Tuesday at a press conference organized by the National Public Health Coalition following a weekend in which approximately 1,300 HHS employees were fired

; about 700 of those had their termination notices rescinded less than 24 hours later. The Trump administration said those whose terminations were rescinded had been terminated due to a coding error

Reporters at Tuesday morning’s press conference also heard from Aryn Melton Backus, MPH, an employee at the CDC’s Office on Smoking and Health, who has received three different termination notices in the last few months.

“My first termination came during the wave of probationary employee firings,” she said. “On February 14, I was told that I was being terminated for poor performance during my trial period, despite having been on my team for almost 2.5 years and having been recently converted from a contractor to a federal employee. A judge has since ruled that these terminations were illegal.”

“My second termination came on April 1 when my office was eliminated during the agency-wide reduction in force [RIF],” she continued. “At first, I had no way to know if I had received a second termination notice, because my access to the CDC network had been cut off … I was finally able to regain access to my work email, and there was a reduction-in-force notice sent to my work email on April 1.”

“Despite the two termination letters, I’ve remained on administrative leave since February of this year due to a court case challenging the legality of the [first] reduction in force,” Backus said. “When word started spreading about the new reduction force, on October 10, I figured I was safe; a lawsuit [involving] my office prevents us from being further reorganized or fully separated. But then late Friday evening, I started hearing our team had received another reduction in force — a third for me. Luckily, that notice was rescinded less than 24 hours later, but I still remain on administrative leave, unable to do my job. My situation just highlights the chaos and confusion that federal employees have experienced over the past year.”

The American Federation of Government Employees (AFGE), which represents some of the fired workers, is fighting back. “[We are] demanding that all [RIF] notices be rescinded immediately,” AFGE Local 2883 President Yolanda Jacobs said at a separate press conference on Tuesday afternoon. “These illegal firings of our union members during a federal government shutdown [are] a callous attack on hardworking Americans and puts the livelihoods, health, and safety of our members and communities at great risk.”

Jacobs said she didn’t believe the now-rescinded RIFs happened because of an error. “I believe it was intentional,” she noted. “The administration did a whole lead-up campaign before they actually sent the notices out, to the point of even having the [Office of Management and Budget] director go on to X and say that the RIFs have begun. So, to me, it was not an error, those areas where they did reverse.” Instead, she added, the reversals happened because there was a lot of pushback on some of the firings.

One employee who received an RIF notice who was given anonymity in order to speak freely said she asked whether she could take another job while on administrative leave and was told she needed approval from the ethics office to be sure there wasn’t a conflict of interest. When the employee asked who she needed to contact in the ethics office, they said, “Well, you can’t, because they all got RIF letters too.”

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My time that I am capable of dealing with my blog and pt’s issues may get restricted going forward. We were just told that the independent pharmacy that we have been patronizing for abt 10 yrs is not going to be in the Humana  Part D next year!  This guy owns the only two independents in our county. Open enrollment starts in a couple of days for Medicare.

Our PCP told us the first of this year, that he is retiring at the end of 2026. However, he has had a hip joint replacement.. which apparently got infected and the hip joint is DEFECTIVE and he is to put no weight on the defect hip joint for at least 12 weeks.

We have also been told that the practice that our PCP is in – it has 10-12 practitioners – is developing a consensus for the practice in how they are going to treat pain. In the real world if a number of business people agreed to do something the same way it would be referred to as a COLLUSION – NOT A CONSENSUS.

I talked to the office manager last week and I asked for a copy of this “consensus” and she said that they had not put it to writing… I suggested that might be a very good thing for them to do.

Going forward, I am going to focus my time on adding to the “ACTION” tab and putting pt education information there. 

I am not going to “share” on all the FB pages like a normally do with additions to the “ACTION” page.  Below is where you can put your email into a place on the left column on the first page of my blog and Word Press will send you a email that I had made a new entry and/or look for the last 4-5 new posts that are listed in the same column

Below is a picture of the desk in the room that I call “my office”, this is where all “the magic happens :-)”. We knew that we were most likely going to have to change practitioners at the end of 2026 – if we can find one, but maybe having to change pharmacies as well in a couple of months, and now not knowing if our PCP will be coming back to the practice.

I may end up spending a lot of time trying to ADVOCATE for Barb and myself. If my blog ends up going sort of quiet, everyone will understand why!

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