Doc had a feud with WalMart Pharmacy and their is no question that the local Walmart retaliated against my family physician by using the DEA

Pain medicine was a by-thought to me. My main medicine was Lorazepam 3 x a day that saved my life 24 years ago when a respected psychiatrist ruled out other medicines and put me on it.
I had severe panic disorder that had destroyed my life. For 24 years, I lived a normal life with this simple medicine, not even a narcotic.
My Psychiatrist retired and called my PCP in 2012 to continue the lorazepam established treatment.
My PCP agreed to continue the care. My family doctor, who’s elderly now, also was the last physician to treat cancer patients, the elderly, and provide end of life care pain relief to local residents.
HE WAS JUST RAIDED BY THE DEA last month. He had a feud with WalMart Pharmacy and their is no question that the local Walmart retaliated against my family physician by using the DEA.
Quitting my simple lorazepam suddenly can actually cause death. 2 of my 3 refills were invalidated, even though I have the soonest appointment to see another Psych in May.
I’m down dosing myself and I’m physically now at significant risk of seizures and death. My blood pressure writing this is at 170/110, pulse 90 because I’m down dosing myself for lack of any help in the medical field. My pharmacists feels helpless because he knows I don’t abuse medicine and is well aware of my disorder.
Because my family doctor was busted by the DEA for treating patients humanly, I can’t go to an ER because I would be labeled a drug addict, even though Lorazepam withdrawals can kill and isn’t even a narcotic!
I just want my life back, but since I will run out of simple anxiety medicine. I may not survive more than a month from now. It’s not like I’m 20 and healthy and can adjust. My heart literally can’t take it.
Please sign me up to sue the DEA in honor of my physician and for the HELL I’m going through even though I was a law-abiding citizen who took my medicine responsibly!

WE’VE LOST YET ANOTHER BEAUTIFUL SOUL….FELLOW WARRIOR SONYA WHITE HAS PASSED

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WE’VE LOST YET ANOTHER BEAUTIFUL SOUL….FELLOW WARRIOR SONYA WHITE HAS PASSED
💜💜😢😢REST IN PEACE SWEET ANGEL 😢😢💜💜

FROM HEATHER VAN WOLF:

It is with great sadness that I must share this news.

Our beloved member, advocate and warrior for the Coalition for the Terminally Ill Disabled and Elderly Sonya White has passed away on Thursday March 7, 2019 at 30 years old. She is survived by her two beautiful children, her loving husband, family and friends.

Many of you knew Sonya as a vibrant vocal advocate with a witty sense of humor fighting for those living with severe pain who were mistreated and discriminated against in hospitals, doctors offices and pharmacies.

Sonya asked that we not be silent about her terrifying struggle to obtain even the most basic medical care.

Sonya lived with an aggressive glioblastoma wreaking havoc to her mind and body without being diagnosed or treated until it was untreatable and terminal.

Sonya sought medical care for seven years, having developed a deep mind body connection and feeling that “something was not right in her head.” Doctors would not take her complaints seriously.

Suffering severe pain and mobility issues, Doctors repeatedly ignored her complaints and due to patient profiling, refused to administer rigorous diagnostic tests and repeatedly sent her away misdiagnosed as malingering, mood disorder or psychosomatic illness all while the cancer spread through her brain . Refused diagnostic tests meant Sonya could receive no treatment for the increasing signs and symptoms from the brain cancer.

Sonya asked that we share her life story because this alarming abuse of her most basic human right to life-saving diagnostic testing is becoming epidemic.

The discrimination she faced is increasingly common in the US, UK, EU and in Ontario as hospitals and doctors are deputized by law enforcement to assume all patient complaints of pain are likely malingerers, drug addicts, psychiatric patients or alcoholics.

She fought hard to stop patient-profiling which denied her the most basic life-saving medical care. People who complain of pain or who dress a certain way or look a certain way are being triaged right out of society.

We have lost a hero for the terminally ill disabled and elderly. Sonya’s girls lost their precious mother and we have lost a friend.

She was a valiant mountain climber on an invisible mountain and she will remain in our hearts and minds forever.

Sending love and light to you precious Sonya. You are loved forever.

As seen on the web 03-15-2019

Dr. Ginevra Liptan

Today, I traveled to Salem to testify again in front of the committee that will determine the proposed State opioid policy outcome.

If it were to pass, the policy mandates Medicaid patients with certain chronic pain conditions, including fibromyalgia, be forcibly tapered off of their opiates. Chronic pain patients need more tools, NOT less. In the video below you can hear my testimony and further thoughts on this extremely important issue.

Linder v. United States

Linder v. United States

https://en.wikipedia.org/wiki/Linder_v._United_States

Linder v. United States, 268 U.S. 5 (1925),[1] is a Supreme Court case involving the applicability of the Harrison Act. The Harrison Act was originally a taxing measure on drugs such as morphine and cocaine, but it later effectively became a prohibition on such drugs. However, the Act had a provision exempting doctors prescribing the drugs. Dr. Charles O. Linder prescribed the drugs to addicts in Moore, Oklahoma, which the federal government said was not a legitimate medical practice. He was prosecuted and convicted. Linder appealed, and the Supreme Court unanimously overturned his conviction, holding that the federal government overstepped its power to regulate medicine. The opinion of the court was written by Justice James Clark McReynolds and states, “Obviously, direct control of medical practice in the states is beyond the power of the federal government.”

Ohio Drug Overdose Data Good News for Chronic Pain Patients

www.cergm.carter-brothers.com/2019/03/14/ohio-drug-overdose-data-good-news-for-chronic-pain-patients/

I’ve monitored Ohio’s efforts to collect drug overdose data since 2015 and until now, it’s been discouraging, showing overall rising rates between 2000 and 2017. But new data shows an encouraging trend in the fight against illegal drug use, more importantly the data blows holes in claims that chronic pain treated with opiates is a leading cause of drug overdose deaths.

Prescription Opiate Data

First, the overall death rate from prescription opiates shows a solid trend of decreases since 2011. Clearly Ohio’s efforts at collecting specific data points on prescribed opiates is now having a payoff.

 

Ohio Unintentional Prescription Overdose Deaths 2011-2017

 

 

 

 

 

 

 

 

 

Second, the number of written scripts from physicians is down dramatically. It’s likely this data point hides a more ominous statistic, that of the number of patients who have legitimate medical conditions which qualify them for treatment with opiates, but have been denied treatment due to the backlash of sentiment around treating chronic pain with opiates combined with fear physicians have from state medical board regulations.

Ohio-Number-of-Prescription-Written-2011-2017
Ohio Number of Prescription Written 2011 2017

 

Third, Ohio’s prescription drug monitoring program identifies people  attempting to fill scripts from multiple doctors. While overall this is also good news, it too may hide an ominous data point which remains unknown, that of patients with legitimate medical problems who are under prescribed due to the backlash of sentiment spurred on by the CDC’s out of context guidelines for treating chronic pain.

 

 

 

 

 

 

 

 

Ohio Number of Doctor Shoppers 2011-2017
Illegal Opiate Data

Forth, the percentage of overdose deaths from Fentanyl as compared to other opiates has seen a dramatic increase since 2003 while deaths from other sources continues to decline. This is now signalling that more effort and funding are needed for law enforcement in thwarting this scourge of drug abuse.

 

 

 

 

 

Ohio Fentanyl Related Drug Deaths 2013-2017
Ohio Fentanyl Related Drug Deaths 2013-2017

 

 

 

 

 

 

 

 

 

 

 

Fifth, when comparing trends on selected opiates, clearly prescription opiate overdose deaths are declining. Heroin deaths have had mixed but improved outcomes, benzodiazepeines deaths are down while deaths from cocaine and methamphetamines have risen since 2010.

Ohio Percentage of Unintentional Overdose Deaths by Drug 2010-2017

 

 

 

 

 

 

 

 

 

Overdose deaths by age group remain relatively unchanged. While many argue that those aged 60 and older have a higher risk, the data doesn’t support such conclusions.

Ohio Fentanyl and Related Drug Unintentional Overdose Deaths by Age and Sex 2017

 

 

 

 

 

 

 

 

Sixth, when comparing Fentanyl overdose deaths to drug seizures by law enforcement, the news is encouraging but a clear trend is still lacking. We know that Fentanyl and Carfentanyl overdose deaths have increased since 2011, but this data would suggest more funding and effort is needed with law enforcement to fight this crisis.

Ohio Fentanyl Drug Deaths Compared to Drug Siezures 2015-2017

 

Seventh, the data points on this graph have been updated from previous graphs to now separate prescription opiates from illegal opiates. We know that most death certificate data does not make a differentiation between prescription opiates vs illegal opiates. So agencies in Ohio have started collecting data from other sources as documented in this post.

The rise in illicit Fentanyl deaths since 2013 is alarming, demonstrating how some people who had access to prescription opiates turned to illegal sources. This too may hide a ominous trend which is not investigated and reported. Patients who have been denied treatment due to the general sentiment towards opiates and fewer prescribers writing scripts for otherwise legitimate medical conditions.

 

 

 

Ohio Unintentional Overdose Deaths Using Selected Drugs 2000-2017

 

 

 

 

 

 

 

 

 

In large part due to the rising rate of illicit Fentanyl overdose deaths, the number of overdose deaths per 100,000 population remains at an all time high. Still for those who claim that treatment of chronic pain with opiates is a leading cause of overdose deaths, the data from Ohio no longer supports this claim.

Ohio Overdose Death Rate by Population 2001-2017

 

 

 

 

 

 

 

 

 

 

This graph also underscores how illegal drug use has been and remains the number one cause of overdose deaths in Ohio. As of 2017 70% of all overdose deaths are from Fentanyl, 20% from Heroin, 31% from Cocaine and 10% from prescription opiates.

Ohio Unintentional Overdose Deaths Using Specific Drugs 2005-2017

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

It’s been know since the start of the opiate crisis that most overdose deaths result from a combination of drugs. This is a new graph showing those combinations of drugs in Ohio. Fentanyl and Cocaine make up the largest group at 22%, followed by Fentanyl and Heroin at 14%, followed by Fentanyl and prescription opiates at 9%.

These stats are very revealing, showing that even with prescription opiates, those dying from these combinations are most likely illicit drug users and not chronic pain patients.

Ohio Unintentional Overdose Deaths Drug Combinations 2007-2017

 

This data from Ohio is unprecedented in its scope and detail, supporting what the chronic pain community has been saying since the onset. Improved methods at monitoring, in data reporting and collection, physician use of this data combined with better screening for drug abuse is finally producing a picture which is rational and believable.

Ohio has committed to being a leader in the war on illicit and illegal drug use. This data is encouraging and good news for chronic pain suffers. Still, we know from individual reports this data hides another view which is troubling and an underlying cause of the increased number of suicides. That of fear driving prescribers to kick some patients to the curb and denying them access to healthcare. 

I only hope Ohio will exercise as much due diligence in uncovering this aspect of healthcare for Ohioans as they have in fighting the drug abuse war.

 

Surprise Turn at Oregon Health Meeting on Forced Opioid Taper Proposal

ww.nationalpainreport.com/surprise-turn-at-oregon-health-meeting-on-forced-opioid-taper-proposal-8839121.html

The highly anticipated meeting in Oregon to consider a policy to force taper some Oregon Medicaid pain patient who use opioids took a surprising turn.

The head of the Oregon Health Authority called off today’s review in light of potential conflicts of interest by staff.

Dr. Catherine Livingston is a family medicine physician who serves as a contracted medical consultant to the Health Evidence Review Commission (HERC). In addition, she is a co-investigator on two studies evaluating the impact of HERC’s previous decision to expand pain management coverage for people suffering from back pain.

“It is vital for the Oregon Health Plan to cover safe and effective therapies to help people reduce and manage chronic pain. Yet it is also vital that Oregonians have full confidence in the decisions the HERC makes to assess the effectiveness of health care procedures,” OHA Director Patrick Allen said in a statement published in this press release released on Thursday.

Apparently, Dr. Livingston’s potential conflict was uncovered by a chronic pain activist who has been fighting HERC’s attempt to force taper any pain patients.

“We are pleased that the OHA is taking time to investigate possible conflicts of staff, consultant and commission members,” said Amara M., who prefers we don’t use her last name. “We believe there are other possible conflicts.”

The HERC proposal has received withering criticism from providers who treat chronic pain from across the country and as recently as last week the commission received a letter from Stanford’s Sean Mackey and other pain leaders who wrote:

“We continue to have grave concerns with the primary goal of the current proposal, namely, its call for non-consensual forced tapering off prescription opioid analgesics of a broad class of patients.”

Sean Mackey, M.D., Ph.D., is Chief of the Division of Pain Medicine and Redlich Professor of Anesthesiology, Perioperative and Pain Medicine, Neurosciences and Neurology at Stanford University. He is a Past President of the American Academy of Pain Medicine.

For chronic pain advocates in Oregon, today’s delay allows them to continue to work to educate HERC members and the general public about what the advocates believe will cause real damage to chronic pain patients.

“Maybe they can take the time to read Dr. Mackey’s letter and other communications by people who treat chronic pain about what a horribly bad idea forced opioid tapering is,” said Amara M.

Sharing is caring

Attention: Dr Tennant who supports us chronic  pain patients is asking that we patients —wright Paul Ramsey letters and get Jane Ballantyne fired and removed !!!
she’s the one who’s culpable in getting the CDC to write the restrictions and she’s claiming we don’t need opiodes and she stated that we pain patients need to embrace our pain and accept it !!!

now Dr Tennant is asking that we write letters to Paul Ramsey Who is the CEO of the UW medicine and Dean of school of medicine and ask for Jane Ballantyne removal immediately along with Sullivan they are both prop members who have caused this mess..
Please help n share.

Drug importation is not the solution to prescription drug costs

Drug importation is not the solution to prescription drug costs

https://www.bendbulletin.com/home/6981704-151/guest-column-drug-importation-is-not-the-solution

State lawmakers are tired of waiting on their federal counterparts to act on prescription drug prices.

The state Senate recently held a hearing on a bill that would call on the Board of Pharmacy to import prescription drugs from Canada. A companion bill, which would require the Oregon Health Authority to enact an importation program, is pending in the state House of Representatives.

As a pharmacist, I see and feel my patients’ pain from the high cost of medications that only seems to grow more expensive each year. Their frustration is my profession’s collective frustration too.

I can understand why they — or anyone — would think purchasing drugs from outside the U.S. would make prescriptions more affordable.

Yet importing prescription medication from Canada or other countries would be a cure worse than the disease. It would threaten what patients need even more than lower prices: safety and choice.

Our patients’ safety is our top concern, and the reality of so-called “Canadian” drug sites is that most are not Canadian, nor do they sell Health Canada-reviewed or approved medications. A 2017 review by the National Board of Pharmacies showed many of these sites do not require a valid prescription — a troublesome prospect in light of the nation’s opioid crisis.

Worse, several were found to sell counterfeit medications. The World Health Organization estimates that 1 in 10 medicines in developing countries is counterfeit — a significant public health threat, which Americans are immune to given the Food and Drug Administration’s “track and trace” system that is the safest in the world.

Consider the ramifications of counterfeit medicine. A fake Rolex may give you the wrong time, but it won’t kill or maim you.

As a pharmacist, my job is to know what’s in my patients’ medications and how to mitigate potential side effects and drug interactions. The problem with fake medications is there’s no way to know what’s in them until it’s too late.

Even if state health authorities could somehow verify the safety of Canadian drugs, it’s Pollyannaish to believe that Canada, which is experiencing widespread drug shortages, would allow its limited supply to be exported.

Christopher Ward, a Canadian health consultant explains that “in Canada, we have faced significant drug shortages. There’s no way there’d be support for this type of operation.”

And even if Canada had excess supply, it likely wouldn’t sell to the U.S. at the same price Canada charges its citizens. Doing so would cause public outcry given the chronic funding shortfalls experienced by the country’s universal health care system.

“Canada’s pricing controls don’t apply to exports,” notes Canadian health care expert Tim Squire.

Foreign countries like Canada are able to offer their citizens cheaper drug prices because their governments use price controls. This is unfair to American patients who are forced to subsidize the artificially low cost of these drugs in foreign countries. Yet foreign patients pay the price in lack of access. If manufacturers can’t meet the low prices demanded by governments, their citizens simply go without.

Canadians only have access to about 50 percent of the new medicines that Americans enjoy. That number falls to just 33 percent for Australians.

So what’s the solution to rising drug prices if not importation? Reforming the opaque supply chain. Transparent prices, absent middlemen who increase drug prices by more than $150 billion annually, can reduce costs in the same way they do in virtually every other sector of the economy.

In the meantime, Oregon shouldn’t fall for the siren song of prescription drug importation.

U.S. Government Wants to Use Social Media to Decide Who Is ‘Disabled Enough’ for Disability Benefits

U.S. Government Wants to Use Social Media to Decide Who Is ‘Disabled Enough’ for Disability Benefits

https://themighty.com/2019/03/social-security-disability-benefits-monitoring-social-media/?utm_source=engagement_bar&utm_medium=facebook&utm_campaign=facebook_share

The U.S. government wants to use your Facebook posts to decide if you’re disabled.

According to the New York Times, the Trump administration is proposing that Social Security Administration officials routinely examine the social media accounts of people who have applied for or receive disability benefits as part of determining whether they qualify. The policy is not specifically outlined in Trump’s recently released budget, though it does mention allowing the SSA to “use all collection tools to recover funds in certain scenarios.” The budget would have to be approved by Congress before going into effect.

This proposal has alarmed disability advocates all over the country. However, most of the objections raised in the media have failed to address the real dangers of such a policy to individuals with disabilities and the disability community as a whole.

In an Engadget report on this issue, Electronic Frontier Foundation senior staff attorney Adam Schwartz said, “When a disabled person posts a picture of themselves doing something a disabled person should not be doing, it is not necessarily evidence of fraud about government disability benefits.”

Attempting to determine whether someone is disabled using social media can only be done by relying on inaccurate, damaging stereotypes about what disability looks like and what disabled people can and can’t do. It’s based on the false assumption that if someone is “really” disabled, they must be utterly miserable, stuck at home all the time and unable to function in life. If they aren’t, they must be faking and living it up on the government’s dime. But that couldn’t be further from the truth.

The New York Times article states that examiners could look at social media for evidence that a person is working or is able to work. But what exactly does “disabled” look like? How a person appears in photos and videos tells you very little about their physical and mental health. Just because you see someone doing something doesn’t mean they can do it on a regular basis, and you can’t see how much pain they’re in or the price they pay afterward.

Stories and studies have shown that people often present themselves in the best possible light on social media, smiling even when they’re in pain and struggling. People with disabilities may share the joy of having a good day, joining their family for a backyard barbecue or even going on vacation. They may or may not feel comfortable talking about medical appointments, treatments and bad days when just getting out of bed hurts.

If someone mentions “working” on social media, that could mean a lot of different things. Perhaps they volunteered at the animal shelter or sold handmade jewelry at a local market. It doesn’t mean they are capable of SGA (substantial gainful activity), the measurement of ability to work under Social Security rules. They could be working and earning under the SGA limit, or be employed while receiving benefits, which is possible through the SSDI ticket to work or a state Medicaid working disabled program. If they have impairment-related work expenses such as out-of-pocket medical bills or privately-paid personal attendant care, they can deduct those costs from the income they’re allowed to earn while receiving benefits.

There are people with physical disabilities who ski, skydive and ride horses. These activities can be therapeutic and improve physical and mental health. They have nothing to do with whether someone requires disability services.

SSDI and SSI are not an easy path to “free money.” Qualifying for these programs involves complicated paperwork, medical exams and months or years of waiting. Most applicants are turned down the first time and must go through an appeals process that usually takes years and involves being questioned and doubted at every turn. Mighty contributor Sunny Ammerman described the ignorance she faced from a “vocational expert” at a grueling SSDI appeal hearing she recently endured:

She said I could work in a call center. Did she not hear me when I told the judge that my optic nerve hypoplasia causes me to have to take breaks from looking at computer screens so I don’t get intense headaches from eyestrain? … She said I could work as a ‘line worker’ assembling simple parts in a factory. Did she not hear me explain that my bouts of fatigue cause me to have to lie down at a moment’s notice? What factory foreman is going to put up with that?

Ammerman’s lawyer argued strongly against the “expert’s” poorly-justified assertions, but as of this writing, she’s still waiting to find out if she got approved.

People with disabilities who make it through this agonizing process and obtain benefits do not sit around getting rich off government funds. The money is usually not even enough to afford basic necessities. Could you get by on $771 per month, the SSI benefit for 2019? SSDI is typically a bit higher, with the average around $1,200 per month. That’s still not enough to live on in many places, and certainly not enough to be worth fighting for benefits if a person has other options. Many people with disabilities have no choice but to work a little while on benefits even if it’s a struggle because the alternative would be homelessness.

For others, the most important part of qualifying for SSDI or SSI is having access to healthcare through Medicare and/or Medicaid. People with significant physical disabilities who need personal care assistance for tasks like dressing and bathing have no choice but to obtain disability benefits because no private insurance pays for in-home care. They may want to and even be able to work, but must utilize limiting “working disabled” programs to keep their Medicaid attendant care.

The Social Security Administration already puts people through hell just to get what amounts to a very small, frankly inadequate amount of support. And now they want to spy on our social media too?

The idea that a productive day or a smiling photo could put people with disabilities at risk of losing the services we need to live is absolutely terrifying. I am a travel blogger, so I have pictures and video of myself at locations all over the country going to concerts, visiting the beach, camping and living my life to the fullest. I was in pain or exhausted when some of them were taken, but you can’t see that. I had a Medicaid-funded personal care assistant with me to help me bathe and dress, but she’s not in the pictures. However, you can see my wheelchair, which proves that enjoying life and posting about it online doesn’t mean someone isn’t disabled. I am rocking out to music while disabled, enjoying the ocean while disabled, and exploring the woods while disabled. I’m severely disabled and I can live my life because of SSDI, Medicare and Medicaid. Will I now be punished for actually doing so?

Government surveillance of social media puts all people with disabilities in danger, but would disproportionately harm those whose conditions don’t have obvious external signs or require the use of mobility aids. People with invisible disabilities already struggle to get the support they need because strangers, doctors, friends and even family members dismiss their needs and say they “don’t look sick.” They would be the first targets in what amounts to a modern-day witch hunt against those perceived as “not disabled enough” in the eyes of the public. If they do the things I do without visible “proof” of disability, they’re far more likely to be questioned and doubted, which is both unfair and dangerous.

Judging the legitimacy of disabilities based on social media posts could cause disabled people to lose life-sustaining services and even lead to violence. For evidence of this, we need only look at the U.K., where government rhetoric surrounding benefits fraud has contributed to a steady increase in hate crimes against disabled people. Many have reported being verbally and physically attacked by strangers who use epithets like “scrounger” to suggest they are faking their disabilities and abusing the social service system.

This proposal and other similar recent policies such as electronic visit verification treat people with disabilities like criminals, subjecting us to invasive surveillance with no right to privacy and no due process. They’re based on fear of fraud — but that unfounded fear causes real harm to real people with disabilities every day.

People who become disabled later in life often struggle with shame because our culture has placed such a stigma on those who receive disability benefits. They may feel guilty on days when they feel well and even question whether they are deserving of help. The Internet is a powerful tool to combat this stigma because it enables us to share our accomplishments and demonstrate how much people with disabilities can do when we have the support services we need.

People with disabilities can find emotional support and practical advice in online communities like The Mighty. Every day when I read through comments on articles here, I see someone whose life was changed because they found a story by a contributor with their rare disease and now know they’re not alone. I see someone who feels hopeful because a contributor with the same condition as their child went to college and became a teacher. I see someone who joins the fight for disability rights because they read an article about ableism in society and realized we all deserve to be treated with respect and equality.

But what happens if these voices go silent out of fear? How can a person connect with others when they constantly have to wonder if what they say online will be used to hurt them? How can they stop worrying that an ignorant government employee who believes people who receive benefits don’t deserve to be happy could target them because they live joyfully with a disability, or just don’t fit into stereotypes about what disability looks like? Government spying on disabled people could decimate disability support communities and force role models and advocates whose lives hang in the balance to retreat into the shadows. There would be no one left to counter the stereotypes, to show that life with a disability is worth living.

You can be happy and disabled. You can be active and disabled. You can do things people think disabled people can’t do and still be disabled. The Trump administration — and the public — need to understand that disability doesn’t have a look. It often isn’t visible. Government support programs that actually work should empower people to get the care they need and find joy in life, not live in shame and fear.

Why your prescriptions COSTS SO DAMN MUCH !

Reports show pharmacy middlemen making big money in other states

https://www.ohio.com/news/20190314/reports-show-pharmacy-middlemen-making-big-money-in-other-states/1

Pharmacy middlemen are making big money in at least two other Midwestern states’ Medicaid programs, according to two new analyses.

The state-federal health insurance programs for the poor in Illinois and Kentucky appear to be even more profitable for pharmacy benefit managers than they were in Ohio, the research found.

A study in the Buckeye State — one that was prompted in part by an earlier analysis by The Dispatch — found that in 2017, middlemen CVS Caremark and OptumRx charged taxpayers $224 million more for Medicaid drugs than they paid pharmacists, for a margin of 8.8 percent. The analyst who wrote the report said those charges were at least triple the going rate.

An analysis released Wednesday by the Illinois Pharmacists Association shows that just as that state rolled out its Medicaid managed-care system in the second quarter of 2018, pharmacy benefit managers, also known as PBMs, were charging taxpayers 23 percent more for generic drugs than they were paying pharmacists for those drugs.

“It’s in the first quarter of implementation,” said Antonio Ciaccia, a co-founder and researcher with 3 Axis Advisors, which did the report. He also is a lobbyist for the Ohio Pharmacists Association.

Ciaccia said that Illinois’s high “spread” between what PBMs are charging for generic drugs and what they’re paying could be a harbinger of the future. “The data we’re tracking shows that this is a growing problem.”

Greg Lopes, a spokesman for the PBM industry group the Pharmaceutical Care Management Association, noted the Illinois study used data from 21 percent of generic drug transactions to come to its conclusions.

“These types of studies are biased toward one group — independent drugstores — and give an incomplete and inaccurate picture of prescription drug costs in Medicaid,” he said in an email.

CVS, which also operates the nation’s largest drugstore chain, is PBM to most of Ohio’s Medicaid managed-care plans, as it is in Illinois and Kentucky. In its role as a pharmacy benefit manager, it negotiates rebates with manufacturers, determines which drugs are covered by insurance and to what extent.

CVS’s PBM also determines how much retail pharmacies are reimbursed for drugs — a glaring conflict, critics say, since CVS’s retail stores directly compete with the stores for which CVS Caremark determines drug reimbursements. Some groups, including the American Medical Association, are concerned that the marketplace will become even less competitive if CVS’s merger with insurance giant Aetna is allowed to be consummated.

In Kentucky, state officials have been concerned with the amounts PBMs might be making from their Medicaid system. The legislature there passed a bill last year requiring PBMs to provide the state with financial information relating to their contracts with managed-care organizations and the pharmacies they reimburse.

Last month, the Kentucky Cabinet for Health and Family Services released a report showing that in calendar year 2018, PBMs charged taxpayers $124 million more for drugs than they reimbursed pharmacies — a spread of almost 13 percent. A year earlier, the spread was $87 million, or 9.4 percent, the report said.

“These are taxpayer dollars that we can’t identify what is the service they are being used for,” Jessin Joseph, director of pharmacy for Kentucky’s Department for Medicaid Services, told Bloomberg.

Also of interest in the report is that the spread PBMs received on transactions with companies owning 11 or more pharmacies jumped from 11.5 percent in 2017 to 21.6 percent in 2018. That seems to comport with data The Dispatch obtained from the Ohio report indicating that CVS would have to reimburse retail giants Walmart and Sam’s Club 45 percent more to bring them on par with the amounts given to its own pharmacies.

In Ohio, Gov. Mike DeWine has vowed to revamp the method by which PBMs handle taxpayer money, while Attorney General Dave Yost says he is eyeing legal action against the companies.

In Illinois, pharmacists held a press conference Wednesday in the state Capitol after the 3 Axis Advisors report found that managed care hasn’t saved money, it’s just flipped income from pharmacies to PBMs.

“These findings have huge implications for [Illinois] taxpayers who are being ripped off by the built-in-complexities and backroom deals that PBMs use to make themselves look like they are saving the state money,” Monique Whitney, executive director of Pharmacists United for Truth and Transparency, said in a written statement.

Meanwhile, in West Virginia, where pharmacy services were carved out of Medicaid managed care, a new actuarial analysis found that the state saved $54 million — mostly on administrative costs — of $570 million in drug spending for the year ending June 30, 2018.

PCMA spokesman Lopes took issue with that study as well.

“The West Virginia report does not include the amount the state saves in dispensing fees under the managed-care model, and is riddled with mathematical flaws that render the methodology highly suspect, and the results inaccurate,” he said.

In Kentucky, lawmakers are promising better oversight of the companies.

“We have to solve this problem,” Republican Sen. Jimmy Higdon said, according to the Louisville Courier Journal. “We cannot make our independent pharmacists in Kentucky extinct.”