Here's the thing. #1) Nothing about drug dispensing is simple. #2) No one actually wants a perfectly working system, because for that, you'd need an unconscio

Here's the thing. #1) Nothing about drug dispensing is simple. #2) No one actually wants a perfectly working system, because for that, you'd need an unconscionable level of surveillance and centralization, which to be frank, we're rapidly approaching an ACME of to be quite honest, given EHR mandates. #3) the medical/Pharmaceutical Benefits Management industry is a distributed system at it's core. Distributed Sustems are hard, and the system as it stands is optimized toward A rather than C in the presence of P. (CAP theorem) #4) All controlled substances get reported into a centralized narcotics database overseen by the Federal Government, and all Controlled substance prescriptions come off DEA serialized prescription pads. This database, as far as I am aware, is not shared with the States, so they have no visibility into the actual flow until they are told to look out for it. I may be wrong on this one now though. It certainly isn't looked at except in a reactive sense it seems. Now, PBM's are on the look out for that sort of thing, since the Government got egg on it's face and has been taking it out on everyone, but even so, that mmakes me nervous, as I'm wary of insurers becoming proxy medical decision makers.