Sunday, March 17, 2024

Bill to protect independent pharmacies from benefit managers moves after changes; insurers say it would increase premiums

By Melissa Patrick
Kentucky Health News

A bill to set new controls on commercial pharmacy-benefit managers was approved by a Senate committee on March 14 as a measure scheduled to be approved without debate by the full Senate. 

State Sen. Max Wise
The bill's sponsor, Sen. Max Wise, a Republican from Campbellsville, has worked on PBM reform for years. In the 2020 legislative session he won passage of a bill that required the state to hire a single PBM for the state's Medicaid program, resulting in savings of $282 million. 

That said, while thanking everyone who worked on the bill, both for and against it, Wise told the committee that his latest "may be the hardest one that I have worked on yet during my time in this particular legislature." 

Wise walked the Senate Banking and Insurance Committee through a substiute version of Senate Bill 188, with several changes from the original.

He said the original would have prevented a PBM from requiring Kentuckians to receive their prescriptions by mail, from reimbursing a pharmacy that they own at a higher rate than a community pharmacy, stop the steering of patients to pharmacies owned by the PBM. It also would have allowed community pharmacies to fill 90-day prescriptions for maintenance drugs, prohibited higher co-pays at community pharmacies compared to PBM-owned pharmacies, and  protected  community pharmacies from retaliation for providing cost-saving information to patients. 

Wise added that the original bill would have provided a fair dispensing fee, and mandated that PBMs pay pharmacies at least the cost of the dispensed drugs, provided a fair dispensing fee and include community pharmacies in their networks to offer patients the flexibility to choose a nearby pharmacy. 

He then walked through the changes made by the committee substitute. 

He said it excludes prescription drug plans established under Medicare Part D from the legislation regarding self-funded health plans or Employee Retirement Income Security Act (ERISA) plans. 

He said both the original bill and the committee substitute include the phrase "to the extent permitted under federal law" before several sections in the bill.

"The reason for that is the United States Supreme Court in its Rutledge decision greatly limits what authority states have to regulate ERISA plans," he said. "The inclusion of the phrase mentioned means that most of the provisions of Senate Bill 188 will not apply to ERISA plans; it is likely that only the fair dispensing rate will apply." 

Addressing concerns about imposing the Kentucky Medicaid dispensing rate of $10.64 per prescription on the commercial marketplace, Wise said the substitute addresses this in two ways.

First, he said, instead of using that rate as the dispensing fee floor, the state Department of Insurance would conduct a survey of dispensing costs at both large chain pharmacies and small independent pharmacies. While the DOI is completing the survey, Wise said, the Medicaid dispensing rate will be used as a "gap-fill payment floor."

And unlike the original bill, the protection of the Medicaid fee would only be available to independent community pharmacies as licensed by the state Board of Pharmacy and would not be available to chain pharmacies. 

"So why is it important that we include this gap payment for community pharmacies?" Wise asked. "In the last two years over 68 independent pharmacies have either closed their doors or sold out to chain pharmacies [in Kentucky] due to the massive decline in PBM reimbursements." 

The revised bill also removed, at the request of PBMs and insurance companies, provisions on "white bagging," a practice in which a medication must be prepared and distributed by a third-party specialty pharmacy, instead of allowing providers to prepare, administer and bill for the medication.

Wise added that a health-mandate statement estimates that the bill would raise helath-insurance premiums $1.89 to $25.01 per member per month. The range is wide and essentially unpredictable because there is a lack of reliable data regarding PBM contracts. 

Wise said legislators saw similar estimates when they passed his 2020 bill, but this did not come to pass, and "I feel confident that we will see, just like Tennessee and West Virginia have passed, to not see any increases" with commercial PBM reform, which those states have passed.

Sitting at the table with Wise was Ben Mudd, executive director of the Kentucky Pharmacists Association, and Rosemary Smith, co-founder of the Kentucky Independent Pharmacist Alliance. 

Opponents of the bill

Speaking against the bill were Conner Rose, senior director of state affairs for the Pharmaceutical Care Management Association, the national PBM lobby, and Hope McLaughlin, senior director of government relations for Elevance Health, which operates as Anthem Blue Cross Blue Shield in Kentucky.

Rose noted the high estimate of $25 increase in monthly premiums. "I understand that the purpose of this bill is to help independent pharmacies," Rose said. "But the solution we're talking about today falls on the backs of employers, city and county governments, their employees, the employees of employers in Kentucky, and ultimately individual consumers all across the commonwealth."

He added that the mandates and restrictions in the bill hinder the ability of employers and other plan sponsors to capitalize on the savings that PBMs provide, pointing to how generic drugs offered on the PBM formularies often don't have co-pays or dispensing fees if it comes through the PBMs mail service.  

McLaughlin stressed that the committee substitute was not a compromise and that while they appreciate the removal of the white-bagging provision, she said Anthem still has many concerns about it.  

She said the mandated dispensing fee of $10.64 per prescription "will result in significant, additional health-care costs," and also mentioned the "significant increase" of $25 per month.

And she said the bill "sets a dangerous precedent of putting the General Assembly and the Executive Branch in the role of setting provider reimbursement rates."

But the committee approved the bill without dissent and placed it on the Senate's consent calendar, reserved for bills that are passed on a singke vote without debate. It has 20 sponsors, a bare majority of the Senate.

Besides Wise, they are Republicans Stephen Meredith of Leitchfield, Matthew Deneen of Elizabethtown, Donald Douglas of Nicholasville, Greg Elkins of Winchester, Shelley Funke Frommeyer of Alexandria, Rick Girdler of Somerset, Jimmy Higdon of Lebanon, Jason Howell of Murray, Robby Mills of Henderson, Brandon Storm of London, Lindsey Tichenor of Smithfield, Stephen West of Paris, Phillip Wheeler of Pikeville and Mike Wilson of Bowling Green, and Democrats Karen Berg, Gerald Neal and David Yates of Louisville and Robin Webb of Grayson.

ED visits, hospitalizations for respiratory disease decline in state

State Department for Public Health graphs, adapted by Kentucky Health News
By Melissa Patrick
Kentucky Health News

Kentucky's influenza levels remain elevated, but are declining, and hospitalizations for overall respiratory illness are moderate and declining, according to the state Department for Public Health.

In the week ended March 9, emergency-department visits for the three main respiratory diseases showed a 16% drop in visits for Covid-19, flu and RSV, to 2,734. Of those, 79% of the visits were attributed to the flu. 

Hospital admissions for the diseases dropped 28% in the week ended March 9, to 387. Of those admissions, 216 were for the flu, 154 were for Covid-19 and 17 were for RSV (respiratory syncitial virus).

In the week ended March 9, 10 Kentucky counties had a Covid-19 hospital admission rate between 10 and 19.9 admissions per 100,000 people, a rate that is considered "medium" by the Centers for Disease Control and Prevention. 

Those counties were McCracken, Marshall, Lyon, Livingston, Hickman, Graves, Crittenden, Carlisle and Ballard, in West Kentucky, and Letcher, on Kentucky's southeastern border.

The state reported 2,762 laboratory-confirmed cases of the flu in the week ended March 9 and 1,605 lab-confirmed cases of Covid-19. Both of these numbers have dropped for four weeks in a row. 

Since the flu season began in October, the state has recorded 439 Covid-19 deaths, 110 flu deaths and two co-infection deaths, both reported in recent weeks. One Covid-19 victim and one flu victim were children.

U of L is opening its new hospital in Bullitt County on Monday

University of Louisville photo illustration
Kentucky Health News

The University of Louisville is opening its UofL Health–South Hospital Monday, March 18, with a community breakfast and open house at 8 a.m. and a ceremonial ribbon-cutting with Gov. Andy Beshear at 10 a.m. The hospital will accept its first inpatients that afternoon, a university news release said.

"The $78 million acute-care hospital opens with 40 in-patient beds, and shell space for an additional 20 beds," the release said. "The new hospital fills an access gap in Kentucky’s 10th most populous county, allowing local patients to get their care closer to home. Bullitt County was previously the largest county without an inpatient hospital."

Google map by Kentucky Health News
The hospital is at Exit 121 of Interstate 65. "South Hospital is ideally positioned to support one of Kentucky’s fastest growing regions," the release says. "In addition to inpatient beds, including a 10-bed intensive care unit, the new full-service acute care hospital is bringing more providers. It will also provide enhanced heart-care services . . .for faster treatment of acute heart attacks, expanded emergency capabilities including a ‘fast track’ area for quicker treatment and discharge, expanded cardiopulmonary services, state-of-the art pharmacy, laboratory and sterile processing areas and increased surgical suites for inpatient and outpatient procedures."

Saturday, March 16, 2024

Medical-cannabis 'cleanup' bill passes House; critics disappointed more qualifying conditions not added and say it increases hurdles

By Melissa Patrick
Kentucky Health News

In what the sponsor calls a bill to "clean some things up," more restrictions are being added to the state's medical-marijuana law and provisions were added to allow local school districts to opt out.

State Rep. Jason Nemes
One of the key provisions in House Bill 829, sponsored by Rep. Jason Nemes, R-Middletown, would allow public and private schools to opt out of the program.

Public school boards are required to establish policies related to the use of medical cannabis no later than Dec. 1, 2024. The policies must either prohibit the use of medicinal cannabis on school property, or permit the use with several options for administration, as outlined in the bill. 

The measure would also allow local governments to apply a small local fee to compensate for any additional costs caused by the operation of cannabis businesses; prioritize Kentucky hemp businesses for state contracting; and clarify the powers that the state Cabinet for Health and Family Services has when it comes to inspection. 

It would also abolish the provisional license, which allows someone who makes an application for a license to sell medical marijuana to get the product while the application is pending. Nemes said this "put the cart before the horse."

When the House passed the bill 66-30 on March 12, it allowed the state to move the dates up for licensing, which would allow product to be obtained when the program starts Jan. 1, 2025. 

A floor amendment, filed at the request of the Kentucky League of Cities, was approved to allow cities to be able to opt out of the medical cannabis program before Jan. 1, 2025, even if a licensee had been approved before that date.

The committee substitute for the bill would require a patient to consult with a pharmacist annually to make sure the medical cannabis does not have a negative interaction with the patient's other prescriptions.

That  prompted several Democrats to object in the floor debate, saying the new requirement , with a potential cost of up to $40, imposes another hurdle in accessing medical cannabis.

"It seems like we're adding even more hurdles to make this medicine harder to receive, more expensive for folks to access. . . . I really wish we were back here today to make this medicine more accessible to the people of Kentucky who have been asking us to do this for years," said Rep. Rachel Roberts, D-Newport. 

Rep. Rachel Roarx, D-Louisville, said allowing public school districts to opt out "puts barriers in place" for students who benefit from medical cannabis for conditions such as epilepsy. 

Rep. Josh Bray, R-Mount Vernon, disagreed and supported the opt-out provision for schools, saying that he recognizes the need for this because some schools are concerned about the liability of administering a drug that is not authorized by the U.S. Food and Drug Administration.  

Rep. Cherlynn Stevenson, D-Lexington, said she was disappointed that the bill wouldn't expand the list of qualifying conditions that could be treated with medical cannabis, as was recommended by at "statutory advisory board of doctors and nurses appointed by the state licensing boards."

Stevenson said she hoped these conditions would be added in the Senate, where the bill has not been assigned to a committee.

Kentucky Children's Hospital at UK opens center to treat children who are harmed by abuse and neglect, in which Ky. ranks 14th

University of Kentucky and Kosair for Kids representatives celebrate opening of the Kosair for Kids Center for Safe & Healthy Children & Families at Kentucky Children's Hospital. (Photo by Adam Padgett)

By Hilary Brown
University of Kentucky

Representatives from Kentucky Children’s Hospital and the nonprofit foundation Kosair for Kids cut the ribbon recently on the Kosair for Kids Center for Safe & Healthy Children and Families, a new clinic space for the treatment of children harmed by abuse and neglect at KCH, part of the University of Kentucky. This center was made possible by a $2 million gift from Kosair for Kids.

“I’ve spent the better part of my career looking at the challenges that Kentucky faces, especially when it comes to the ability of vulnerable Kentuckians to get care they desperately need,” said Mark D. Birdwhistell, vice president for health system administration and chief of staff, UK HealthCare. “I’ve seen how hard it can be to effect change for Kentucky’s vulnerable citizens, and that’s why I’m so proud of this new center and of what we’ve been able to accomplish with the partnership of Kosair for Kids.”

Kentucky ranks 14th in the country for child abuse and neglect; according to the state Cabinet for Health and Family Services, in 2022, 11,002 children experienced neglect, 1,146 suffered physical abuse and 756 were victims of sexual abuse. Those numbers have decreased over the years, due largely to the efforts of Kosair for Kids and their partners across the state.

“Today we celebrate opening a center dedicated to giving the best to children who have experienced the worst, said Barry Dunn, Kosair for Kids president and CEO. “Our goal, our aspiration, is that this center serves as a beacon of hope for children who have experienced unfathomable trauma. We stand with them, united in purpose, on the road to healing. We are proud to call them a Kosair Kid, and we want to show them the love and care they deserve. Kosair for Kids is proud of this place, the skilled and dedicated staff on the front lines of this epidemic, and the growing alliance we have formed to protect all children.”

“I’m an ardent believer that you can’t separate physical health from mental and emotional health,” said Dr. Scottie B. Day, physician-in-chief at Kentucky Children’s Hospital. “Maltreatment and childhood trauma have effects that ripple out into adolescence and adulthood and continue to inform patterns of behavior for generations. Through our partnership with Kosair for Kids, we can disrupt generational cycles of abuse and make Kentucky much safer for kids.”

KCH is home to one of only two pediatric forensic medicine programs in Kentucky. Of the five child-abuse pediatricians practicing in Kentucky, four are at KCH’s Division of Pediatric Forensic Medicine along with specially trained advanced nurse practitioners, social workers and psychologists.

Features of the new clinic include:
  • Secure and private space to provide trauma-informed care, including three exam rooms and two therapy services rooms
  • Proximity to the Makenna David Pediatric Emergency Center and other services such as radiology and sedation with private entrance and egress to those sites
  • Space for therapeutic interventions, evidence storage and consultation with law enforcement and other partners
  • Technology to consult virtually with the child’s care team which may include state child protective services, guardian ad litem and law enforcement.
The pediatric forensics staff also provides regular education to medical students, family medicine providers as well as community organizations. They developed a core curriculum for the Department of Community Based Services in the Cabinet for Health and Family Services that includes 16 one-hour lectures. Forensics providers lead a multi-hour training to each new class of Kentucky State Police cadets, as well as continued education to healthcare providers in the community.

Children who are abused and neglected may suffer immediate physical injuries, but also may have emotional and psychological problems, such as anxiety or posttraumatic stress. Over the long term, children who are abused or neglected are also at increased risk for experiencing future violence victimization and perpetration, substance abuse, sexually transmitted infections, delayed brain development, lower educational attainment, and limited employment opportunities. Chronic abuse may result in toxic stress, which can change brain development and increase the risk for problems like posttraumatic stress disorder and learning, attention, and memory difficulties.

All Kentuckians are mandated reporters of child abuse and neglect. If you believe a child is being abused or neglected, call the Child Protection Hotline at 1-877-KYSAFE1 or 1-877-597-2331 or report online.

Friday, March 15, 2024

State Senate restores most Medicaid cuts made in the House

Dr. Bill Collins treats a patient at the Red Bird Mission dental
clinic in Clay County. The Senate budget would increase
dentists' Medicaid fees. (Ky. Lantern photo by Deborah Yetter)
By Deborah Yetter
Kentucky Lantern

The state Senate has largely eliminated cuts to Medicaid that were proposed in the House budget. A top state official had warned the House plan would create a hole next year in the federal-state health plan that covers 1.5 million low-income Kentuckians, a third of the state's population.

“We are pleased that the Senate’s proposed budget restores funding to Medicaid so patients can continue to access the necessary health care services they’re accustomed to,” said a statement from the Cabinet for Health Services, which manages the $15 billion a year federal-state program.

Cabinet Secretary Eric Friedlander appeared before the Senate Appropriations and Revenue Committee last month, along with John Hicks, budget director for Democratis Gov. Andy Beshear, asking the Republican-majority Senate to consider restoring the funds the House cut for the fiscal year that begins July 1.

“This creates a hole in the Medicaid budget for Fiscal Year '25,” Hicks told the committee.

Advocates worry the House plan could force cutbacks in Medicaid services through more than $900 million in cuts to the amount sought by Beshear.

Republicans generally have expressed support for the Medicaid program that pumps money into hospitals, clinics, pharmacies and other medical services throughout the state—with 70% to 80% of the funding provided by the federal government. But some have expressed concern it has grown so large.

The Kentucky Center for Economic Policy told the Lantern last month that overall, the House plan cut about $139 million in state funds Beshear sought for Medicaid in fiscal 2025, which would cause the state to forfeit another $783 in federal matching money, for a total of around $922 million.

The Senate moved its budget bills through committee and to a final floor vote on Wednesday. Dustin Pugel, policy director for the center, said Thursday it appeared the Senate had restored most of the funds but made some cuts including a reduction in “waiver programs” for people with disabilities.

The House plan included about $200 million — about $143 million of that in federal funds — for 2,550 new slots in Medicaid “waiver” programs such as "Michelle P." that provide housing, therapy or other supports for people with disabilities.

Thousands of people are on waiting lists for such services, which generally have been increased by only 50 or so each year.

The Senate version reduces the number of slots over the next two budget years to 1,925.

The Senate did not fund proposed “mobile crisis units,” which were also left out of the House budget. They would provide an alternative to police intervention when someone is experiencing a mental-health crisis.

But the Senate did include an increase in Medicaid payments for dental services, which oral-health advocates say is urgently needed to attract more dentists to the program in a state with high rates of dental disease.

Overall, Pugel said, the Senate plan is “good news for the Medicaid budget.”

However, the budget process is far from over. The House will consider the Senate changes, and if it disagrees, as is usually the case, the budget will bedecided by a House-Senate conference committee.

Anthem loses court fight to keep managing Medicaid for 172,000

Kentucky Medicaid dashboard, which has numbers for each county;
FFS means "fee for service," which is separate from managed care.
Kentucky Health News
 
Anthem Kentucky has failed in its attempt to remain as the manager of Medicaid coverage for about 170,000 Kentuckians, because the Kentucky Supreme Court deadlocked on the insurance company's appeal of a Court of Appeals ruling that upheld the state's decision to give the work to five other insurers.

Anthem had questioned the bidding process, and Franklin Circuit Judge Phillip Shepherd ordered rebidding, but some of the other managed-care companies appealed, and in 2022 the state Court of Appeals overturned Shepherd's decision.  

On Anthem's appeal to the Supreme Court, argued last week, the justices were divided 3-3, meaning that the Court of Appeals decision stands. Justices Angela McCormick Bisig of Louisville, Robert Conley of Ashland and Michelle Keller of Northern Kentucky voted to affirm the appeals court, while Justices Debra Hembree Lambert of Somerset, Christopher Shea Nickell of Paducah and Chief Justice Laurance B. VanMeter of Lexington voted to overturn it.

The seventh justice, Justice Kelly Thompson of Bowling Green, did not hear the case and did not vote. He told Kentucky Health News that he was disqualified because he was involved in the case while he was on the Court of Appeals.

Anthem had remained a Medicaid manager pending the outcome of the case. Asked what will happen to the 170,000 Medicaid members whose care the company manages, Cabinet for Health and Family Services spokesman Brice Mitchell said in an email, "The cabinet’s goal is for no Kentuckian to be without health coverage as it is a basic human right. We are responsible for complying with court orders and will do so once the case becomes final." That is usually 30 days after a decision, the deadline for asking the court to rehear the case.

The current managed-care contracts expire at the end of 2024, so Anthem will have another chance to get part of the business from the program, which spends $15 billion a year in Kentucky, more than 70 percent of it federal money.

Baptist settles dispute with Humana, but not United and WellCare

Baptist Health Lexington
By Deborah Yetter
Kentucky Lantern

Baptist Health and Humana have ended a months-long standoff over Kentuckians with health coverage through Medicare Advantage and commercial insurance plans, the companies said Thursday, March 14. But Kentucky's biggest hospital chain is still on the outs with two other major insurers.

Effective April 1, Baptist physicians again will accept those patients as “in network”— meaning they would not be subject to potentially higher costs or limits on services.

The news, which affects tens of thousands of Kentuckians including many state retirees, was announced through separate press releases.

“After several months of productive negotiations, Humana is pleased to have reached a new, multi-year agreement with Baptist Health Kentucky,” Eric Bohannon, Humana Medicare regional president, said in the release.

Baptist hailed the move as good for patient care. “We are committed to improving the health of our communities and our goal is to ensure every patient the high-quality, timely care needed,” said Dr. Isaac J. Myers II, chief health integration officer for Baptist Health.

The releases didn’t explain how the companies resolved differences that led Baptist Health to drop Humana as a network provider for its physicians on Sept. 22.

Medicare Advantage plans, which oversee health care for most Medicare enrollees, including about 102,000 Kentucky state-government retirees, have been a growing source of contention between health providers and the private insurance companies that offer them.

Baptist has cited delays in payments and denial of care by such private insurers as the source of dispute.

“The concerns we face with Medicare Advantage plans are similar to the concerns expressed by many providers across the country and echoed by hospital associations that represent them: coverage criteria applied by the plans result in denials and delays of medically necessary care to our patients,” Baptist spokeswoman Kit Fullenlove Barry said in January.

Effective Jan. 1, Baptist also ended agreements with United HealthCare and Wellcare for Medicare Advantage coverage for services including physician and hospital care — meaning all such care is considered out of network. Barry said Baptist has not reached agreements with United or Wellcare.

The growth of Medicare Advantage plans has been a source of increasing concern to advocates who argue that patients suffer through practices such as denials of care, delays while care is authorized and other restrictions.

Among those advocates is longtime Louisville health reform activist Kay Tillow, who told the Kentucky Lantern in January that such plans are sacrificing the benefits of Medicare for seniors. “The profit motive is destroying patient care,” she said.

Insurance companies that provide Medicare Advantage plans argue they offer better care at less cost and, in some cases, extra benefits to seniors. But they are able to do that through limiting benefits and patient choices.

Thursday, March 14, 2024

Website that helps Kentuckians find addiction treatment now helps them find naloxone, the drug that reverses opioid overdoses

Photo from Kelley-Ross Pharmacy Group
Kentucky Health News

The FindHelpNowKy.org website, which helps Kentuckians find addiction treatment, now also can help them find places to get naloxone, which reverses opioid overdose.

The website, which has been used over 240,000 times to facilities since its inception in 2018, now also includes social-services resources and locators for recovery housing and mental-health treatment.

In 2022, a Kentucky survey found that 73 percent of respondents said they didn't know where to get naloxone, often known by the leading brand, Narcan.

“We are making it easier for Kentuckians to find the life-saving help they need,” Gov. Andy Beshear said in a press release. “While there is always more work to be done, we are taking another step forward on our mission to help our families fight and overcome addiction.”

Naloxone has become more available thanks to retailers, grants, reduction of stigma associated with addiction, and proactive distribution by community organizations,local health departments, recovery centers and regional prevention centers, the release said.

In addition to the central hub of FindHelpNowKy.org, some of the services can also be reached at FindMentalHealthNowKy.org; FindRecoveryHousingNowKy.org and FindNaloxoneNowKy.org. The latter website provides overdose prevention and response training relevant to people most likely to witness overdose.

“People can and do recover from addiction and mental health issues,” said state Health Secretary Eric Friedlander said. “And our goal of bundling these services in one central location will only make that journey to recovery easier across the continuum of risk.”

The collaborators on this website are the Kentucky Injury Prevention and Research Center and the state departments for Public Health and Behavioral Health, Developmental and Intellectual Disabilities.

“Addiction and mental health issues affect Kentuckians in every county and every ZIP code,” said Dr. Katie Marks, commisisoner of the latter department. “There should be no shame in seeking help and no barriers to finding evidence-based, compassionate care and treatment. These website updates address that at its core – getting our fellow Kentuckians on their road to recovery with resources that are close in proximity and right for them.”

The National Alliance on Mental Illness says 1 in 20 U.S. adults experience serious mental illness each year. In Kentucky, 189,000 adults are reported as having a serious mental illness, the release said.

If you or a loved one are struggling with addiction, the KY HELP Call Center can connect you to treatment by calling 833-8KY-HELP (833-859-4357). Visit the Kentucky State Police website to find a police post where those suffering from addiction can be paired with a local officer who will assist with locating an appropriate treatment program through KSP’s Angel Initiative. Call, text, or online chat 988 to connect with suicide-prevention, mental-health and substance-use-disorder counselors. They are available to all Kentuckians 24/7/365, the release said.

Physician who treats only seniors endorses CDC recommendation that everyone over 65 should get a Covid-19 booster this spring

By Laurie Archbald-Pannone
Associate professor of medicine and geriatrics, University of Virginia

In my mind, the spring season will always be associated with Covid-19.

In spring 2020, the federal government declared a nationwide emergency, and life drastically changed. Schools and businesses closed, and masks and social distancing were mandated across much of the nation.

In spring 2021, after the vaccine rollout, the Centers for Disease Control and Prevention said those who were fully vaccinated against Covid-19 could safely gather with others who were vaccinated without masks or social distancing.

In spring 2022, with the increased rates of vaccination across the U.S., the universal indoor mask mandate came to an end. In spring 2023, the federal declaration of Covid-19 as a public health emergency ended.

Photo from Senior Lifestyle
Now, as spring 2024 fast approaches, the CDC reminds Americans that even though the public-health emergency is over, the risks associated with Covid-19 are not. But those risks are higher in some groups than others. So the agency recommends that adults age 65 and older receive an additional Covid-19 vaccine, which is updated to protect against a recently dominant variant and is effective against the current dominant strain.The shot is covered by Medicare. But do you really need yet another Covid-19 shot?

As a geriatrician who exclusively cares for people over 65 years of age, this is a question I’ve been asked many times over the past few years.

In early 2024, the short answer is yes.

Compared with other age groups, older adults have the worst outcomes with a Covid-19 infection. Increased age is, simply put, a major risk factor.

In January 2024, the average death rate from Covid-19 for all ages was just under 3 in 100,000 people. But for those ages 65 to 74, it was higher – about 5 for every 100,000. And for people 75 and older, the rate jumped to nearly 30 in 100,000.

Even now, four years after the start of the pandemic, people 65 years old and up are about twice as likely to die from Covid-19 than the rest of the population. People 75 years old and up are 10 times more likely to die from Covid.

Vaccination is still essential

These numbers are scary. But the No. 1 action people can take to decrease their risk is to get vaccinated and keep up to date on vaccinations to ensure top immune response. Being appropriately vaccinated is as critical in 2024 as it was in 2021 to help prevent infection, hospitalization and death from Covid-19.

The updated Covid-19 vaccine has been shown to be safe and effective, with the benefits of vaccination continuing to outweigh the potential risks of infection.

The CDC has been observing side effects on the more than 230 million Americans who are considered fully vaccinated with what it calls the “most intense safety monitoring in U.S. history.” Common side effects soon after receiving the vaccine include discomfort at the injection site, transient muscle or joint aches, and fever.

These symptoms can be alleviated with over-the-counter pain medicines or a cold compress to the site after receiving the vaccine. Side effects are less likely if you are well hydrated when you get your vaccine.

Repeat infections carry increased risk, not just from the infection itself, but also for developing long Covid as well as other illnesses. Recent evidence shows that even mild to moderate Covid-19 infection can negatively affect cognition, with changes similar to seven years of brain aging. But being up to date with Covid-19 immunization has a fourfold decrease in risk of developing long Covid symptoms if you do get infected.

Known as immunosenescence, this puts people at higher risk of infection, including severe infection, and decreased ability to maintain immune response to vaccination as they get older. The older one gets – over 75, or over 65 with other medical conditions – the more immunosenescence takes effect.

All this is why, if you’re in this age group, even if you received your last Covid-19 vaccine in fall 2023, the spring 2024 shot is still essential to boost your immune system so it can act quickly if you are exposed to the virus.

The bottom line: If you’re 65 or older, it’s time for another Covid-19 shot.

This article was republished from The Conversation, a platform for journalism by academics.

Wednesday, March 13, 2024

If you are diagnosed with cancer and you smoke, that's one more reason to stop, says UK doctor who co-chaired national survey

Smokers who have cancer have a better chance of overcoming the disease if they stop smoking, but not all cancer-treatment programs do a good job of encouraging patients to quit, according to a national quality improvement project led by the American College of Surgeons.

"The results, published in JCO Oncology Practice, represent one of the largest national surveys examining the quality of tobacco treatment in cancer care in a wide range of clinical oncology settings, including academic facilities and community cancer programs," says a news release about the study.

Timothy Mullett, M.D.
“While many people understand the role of tobacco in terms of causing cancer, they may not understand the impact that tobacco use has when patients are being treated for cancer,” said Dr. Timothy Mullett, medical director of the Markey Cancer Center Network at the University of Kentucky, chair of the surgeons' college Commission on Cancer and co-author of the study.

“Many providers may not think about tobacco cessation in terms of treatment,” Mullett said in the release. “But just like there are effective treatments for high blood pressure or thyroid disease, there are effective treatments for tobacco use. That’s the disconnect we’re trying to highlight in this study.”

Mullett said persistent smoking among patients diagnosed with cancer is associated with many treatment-related complications, including recurrence of the cancer, premature death, and increased treatment costs, Despite these risk factors, polls suggest that nearly 25% of new patients with cancer are smokers, and of the estimated 18 million cancer survivors in the U.S., 16% report they smoke. Many patients report wanting to quit, but fewer than 10% are successful.

The survey by leaders of the surgeons' group found that only 42% of the cancer-treatment programs reported documenting a smoking-cessation treatment plan, 41% reported regularly assisting patients with quitting , providing self-help information (27%), individual counseling (18.2%), and referring patients to an affiliated tobacco treatment program (26%). Only 18% reported regularly prescribing medications for smoking cessation.

“We showed that incorporating tobacco treatment into cancer treatment is feasible and that it can be done in large and small programs,” Mullett said. “Incorporating resources and referrals on tobacco treatment into cancer care requires training and time. Both of those are hard to find in a busy cancer practice, but we need information like this to be recognized by facilities so they can put resources into tobacco treatment and help connect patients with effective resources on tobacco cessation.”

Contrary to Trump's musings, McConnell says efforts to repeal the 2010 Patient Protection and Affordable Care Act are 'largely over'

Senate Republican Leader Mitch McConnell waited for President Biden to arrive for the State of the Union speech Thursday, March 7, in the House chamber. (Pool photo by Shawn Thew, via Associated Press)
Kentucky Health News

Obamacare, now into its second decade, is pretty much here to stay.

So says Senate Republican Leader Mitch McConnell of Kentucky, contradicting former President Trump’s comments that he is still looking at ways to repeal and replace the 2010 law.

“We had a fight over that a few years ago,” McConnell told reporters Tuesday, referring to how Republicans fell short of doing that in 2017 because a few of them opposed the reversal.

“If he can develop a base for revisiting that issue, obviously we’d take a look at it, but it seems to me that’s largely over,” McConnell said of the repeal-and-replace effort, which never had a replacement measure.

McConnell's statement "gave voice to the view shared by many Republican senators that the Affordable Care Act, also known as Obamacare, will be the law of the land for the foreseeable future," writes Alexander Bolton of The Hill.

McConnell endorsed Trump last week, despite their serious differences over more than three years. He said Tuesday, “I’m going to leave the issue development in the presidential campaign up to the campaign.”

Trump said he is “seriously looking at alternatives” if he is elected and Republicans keep control of the House and regain control of the Senate.

“The cost of Obamacare is out of control, plus, it’s not good Healthcare. I’m seriously looking at alternatives,” Trump wrote on his Truth Social site last year. “We had a couple of Republican senators who campaigned for six years against it, and then raised their hands not to terminate it. It was a low point for the Republican Party, but we should never give up!”

Trump exaggerated or misstated the campaign positions of Sens. Susan Collins (R-Maine), Lisa Murkowski (R-Alaska) and the late Sen. John McCain (R-Ariz.), who "voted with Democrats to defeat a narrowed-down proposal to repeal the Affordable Care Act without putting a new health care subsidy program into effect," Bolton notes.

President Biden defended the law during last week's State of the Union speech.

“Over 100 million of you can no longer be denied health insurance because of a preexisting conditions. But my predecessor and many in this chamber want to take — the prescription drug away by repealing the Affordable Care Act. I’m not going to let that happen. We stopped you 50 times before, and we’ll stop you again.”

The main impact of the law in Kentucky has been the expansion of Medicaid to households with annual incomes up to 138 percent of the federal poverty threshold. In February, 1.56 million Kentuckians, more than a third of the state's population, were enrolled in the federal-state program. For details, with county-by-county numbers, go to https://www.chfs.ky.gov/agencies/dms/stats/KYDWMMCC20240215.pdf.