Question from a member of the public

One of our pharmacies (Actually all of them) have a small van that delivered everything direct to them. It's quite possible from the DC's etc, the ones we went to primarly had small box trucks to get the drugs into hospitals. But vans certainly.

That would be a problem from time to time because they come by at the same time of the same days and expose themselves to such a loss of everything in those bins, particularly the narcotics. Im never around when they are delivering from the small van into any of the local pharmacies. The DC in the Little Rock area that handles those vans specifically were hit at the ware house a decade ago for a few million in losses for narcotics theft.

About 2006 the linfield warehouse which handles the whole east coast suffered about a 60 million loss. Roughly. Im not clear on the details but we did in our county capture 4 gang members from Houston maybe a year and change ago that specialized at hitting pharmacies across the entire east and south of Arkansas for over a decade. Small ones. Well unfortunately 4 tried to hit yet another small but which had hardened since the first before them, two were captured at gunpoint in about a minute and change and the other two fled. And 5 counties contained them into a field between a walmart, truckstop and flea market and then about 8 hours into midday they were cornered and caught. I think the legal system escalated that into federal crimes and ended most of the problems in this state.

For now.

It's unfortunate that I am a pain patient and am more aware of the small van end of the delivery day into pharmacies. What happens is one man shows up with dolly to bring a stack of bins several times leaving the side door wide open and unocccupied for a period of time. Its not difficult to take the whole thing. Or take him out with weapons. As a concealed carry when those vans are up and left open like that, my stress levels are into what I call cooper yellow. Near red. So Im not around when they are around. The one pharmacy I go to are also armed as well and they know I carry. So.. that would be a asset.

Most people don't also realize there is a new SIU strike forces being built around this area. If they did try something like that these were our spear point in the Law. Swat mini essentially same as the big cities. They would be there before the van got off the property. It's not going anywhere in our area and 5 to 9 more counties within the hour to two at most would have hundreds show up.

That is probably why the delivery people are relatively low stress.

There is a chance that all the pharmacies in this state might go out of business. The State Legislature had begun a process to regulate for the first time and limit the income of the Middle level managers between Pharmacies and Insurance and state payers. The problem is that the managers since the 80's have taken in hundreds of millions causing each pharmacist to lose about 15 dollars per 100 on every medicine filled. If he served 100 people today and all paid 100, the managers not only got 80+% of the 100 (100 people pay copays of a few dollars if that) and also caused the prices paid by pharmacist to be at a loss.

At some point when Arkansas State house puts a end to this deregulated market of managers pricing drugs below any pharmacist ability to make any profit at all... that will save the entire medical system at it's most local basic access point for medicines. And pharmacies will stop selling at a loss to where they will go out of business entirely. It's possible that if the Legislature fails to regulate this or next year at latest there will be no pharmacy open in Arkansas that is not a actual hospital. I think we are about 3 million people.. 600,000 are medicare/medicaid. And all of them require a refill every 30 days. Never mind what is dispensed short term to thousands a week.

McKesson had gotten into hot water in our time or some what later because of the early shipments of narcotics exceeded the population number of say eastern Kentucky to West Virginia due to over prescribing.

My old clinic as of about 2015 was prescribing no less than 250000 doses of pain medicine to roughly 2100 patients a month. This is public open medicare data availible online under doctors names. And what drugs they prescribe at the state level and versus the national average. You can if you took those 2100 people on 4 seperate medicines for example easily exceed a million doses a month. With a billing rate of about 150 for basic visit and another 250 for drug urine test per each of the 2100 patients (Including me) you are approaching a million per month in gross income as of 2015.

My new doctor is very tiny as far as our clinic goes. His bill for basic visit is 300 and full on drug lab attack for everything is 700. That's a thousand per visit per month. I pay a copay. Insurance has already paid 24000+ to his related and higher chain of clinics for procedures etc. We were looking at about another 70,000 in a nerve burn surgery and related scans MRI to confirm this year alone which would have to be repeated every 8 to 11 months as the nerves rebuilt the connection to the spine which is one of my problems.

Talk about a cash cow. We simply just tabled that idea. I a literally waiting for the state and uncle sam to write to me saying that the plan itself has been canceled because of losses across the board versus a preminum coming in from each patient. I think they take in about 500 a month total and when they are paid out several times that already and not into three months of this year it's not sustainable.

Regular doctors and walk in clinics do not carry narcotics or prescribe them in our area Period. You can check them and confirm that maybe one out of 10 might have prescibed a total of 200 doses of hydrocodone short term for broken arm etc per CDC guidelines. Limited to 7 days per acute medical presentation of that need. Otherwise that patient is sent to the pain clinics which has been pretty grotesque and intense in prescribing and raking in millions.

I hate to be difficult. But this information is a result of about 10 years experience as a patient for that purpose and what has evolved in the last 10 years, specifically the last 18 months alone. We have had 120 people arrested for sales of narctics, 100 pills = 1000 a pint of codine liquid = 5000 and Oxys especially the old Oxycontins which started this whole thing would be 100 per dose. The Oxycontins are off our market entirely. As of 2006. I remember being prescribed those after surgery and they were very very good. Too good actually. They have been replaced by xtampaER which is abuse proof and cost about 700 a month retail in a walmart pharmacy which has to special order that losing 10 days into a 30 day refill cycle. I tried that one once. Realized that the cues I relied on did not exist (The coming up and coming down) and after 6 hours it burned out half life and leaving you another 6 hours in withdrawal until next dose. Three a day was the max lawful prescribing. That would be enough to kill people not used to that type of medicine very easily. They burn it off in 6 hours, take a dose. 2 hours later are fine for 6, take another dose. Next thing they know, by day three they are dead because now they are into what is about LD50 of doses (Lethal versus person's weight)

No wonder we have so many overdoses. They simply go out like to sleep, then quit breathing and about a hour after that they are dead. Leaving everyone to wonder what the hell happened.

edit. As of this year Arkansas has limited the MME of narcotic prescribing daily to less than 60, and if a doctor should prescribe a max of 90 MME (Morphine milligram equivilant.) he has to provide documentation with medical evidence of such prescribing at those levels. 4 x10 mg/325 apap oxycondone in one day equals 120 MME. Which is exceeded by Fentenyal patches etc.) Now it's limited to 3 x 10mg Hydrocodone which is roughly between 30 to 50 MME a day.

A step forward by the State against doctors who keep prescribing too much MME per day to people and cutting down on the overdoses. You hae hydrocodone at he bottom of pain medicine then morphine pills then demerol pills then Oxcycodone which are the tops in power. As far as pills. There are certain special pills reserved for hospice and surgery which MME limits do not apply. In 1990 3 hours after appendix was removed they gave me a oxycontin the size of a small egg. We got it down with some difficulty and that was all that was needed for that day anyway. Nothing else was required once it kicked in. I was out of there in three days.

There are facilities that taken in people who have gone to too much trouble with drugs in legal prescribing and that's one of the reasons the doctors are being limited the way they are. There is a site in little rock with 24 beds. There are thousands who are at risk of additional medical complications such as death, stroke or other losses to withdrawals to either illegal drugs or legal ones when without. Treat ments for a week range from 3000 to 12000. Money most people cannot afford. That's just the medical detox side. Never mind the long term 30 to 90 to 180 or longer days of restricted sites where they are kept off of drugs all together.

 

All who have one goal in mind. Not to send this thread into left field - even though it’s probably already there, but I have to smirk at the supposed altruism of the pharmaceutical and healthcare industries.

As one with a close friend undergoing extended treatment for breast cancer, who recently came this close to getting booted out of a San Diego hospital. Literally onto the sidewalk, while being immune sensitive several hundred miles from home... All over the almighty dollar (500 to be exact) and that’s not even unusual in the land of the free.

I had to Google a solution for her from across the country, since the hospital staff couldn’t have cared less even when its their business.

 

I had a relative who got bad sick from airline all day to Fairbanks. Turned out they did not want her flying back to the USA because it might kill her. We told her to stay home here in Arkansas but noo.. she had to go.

I arranged for a King Air II Medical Flight from Fairbanks to Seattle and then from Seattle to Little rock. Altitude would have been 2000 feet, 4 refueling stops. God only knows how many days it would be in the air for her all the way here. And the medical billing to boot.

To their credit they were stood up and filed a plan and ready and waiting within a half hour at Fairbanks.

However the stupid relative, one of our elderly inlaws bought a commercial flight ticket back to Arkansas against doctors orders. Seattle shipped her to the hosptial for few hours before cutting her loose.

I remember a hosptial called Parkland in Dallas I believe I took sick there and stayed the night. Upon discharge asked for a taxi to take me back to Lancaster for FFE. They could not stand it to kick me out fast enough. Why? The stupid Taxi meter was already running 20 dollars and ticking against their billing.

Sheesh. 2500 dollar workup a 1000 dollar overnight room and board and 200 in medicines plus 60 for ambulance and they lose it all over a stupid 20 dollar taxi ticket. I'll not forget that anytime soon.

 

I know at least one that does. Own the leasing company(through a couple of shell outfits) and make sure it just barely breaks even so you don't have to pay taxes. Then also own the trucking company so you take a 100% writeoff on payments you make, basically, to yourself.

Quite the scam.