Legislative lobbying reports for last session rank pharmacy-benefit managers fifth, hospitals sixth, Altria 11th, Anthem 17th, docs 18th

The legislature meets in the Kentucky State Capitol.

By Al Cross

Kentucky Health News

The trade association for pharmacy benefit managers, which act as middlemen between drug and health-insurance companies, was the fifth largest reported spender on lobbying the state legislature in the first three months of the year, according to a compilation by the Kentucky Legislative Ethics Commission. 

The Pharmaceutical Care Management Association reported spending $94,694 on lobbying the General Assembly from January through March. The session began Jan. 2 and was over for most purposes by the end of March.

On March 28, the legislature gave final passage to Senate Bill 188, which is intended to keep the state's independent pharmacies from closing. It sets dispensing fees, bans PBMs from forcing patients to get their drugs through mail order, and keeps them from steering patients to pharmacies that they own. The PBMs argued that the law will cause insurance premiums to increase and its mandates in the bill won't allow businesses to gain from savings PBMs offer.

Independent pharmacies say they are losing money because of low fees paid by PBMs. The bill sets a minimum dispensing fee of $10.64 per prescription for the state's independent pharmacies until a study of dispensing costs is completed by the state Department of Insurance. This "gap-fill payment floor" will not be available to chain pharmacies. The results of the study will eventually dictate what the dispensing fee should be going forward. The study is to be repeated every two years, with fee adjustments made accordingly.

The law, sponsored by Sen. Max Wise, R-Campbellsville, also prohibits a PBM from reimbursing a pharmacy that it owns at a higher rate than a community pharmacy, or from keeping a community pharmacy from filling a 90-day prescription for a maintenance drug. And PBM will not be able to penalize a community pharmacy from sharing information with a patient on the cheapest option to pay for their medications.

Several other major lobbying interests dealt with health-care issues. The biggest spender was the Kentucky Chamber of Commerce, at $151,010, followed by the American Civil Liberties Union of Kentucky, at $139,599. Among many other things, the ACLU wants the legislature to enact exceptions to the state's near-total abortion ban.

Ranking sixth, just behind the PBM lobby, was the Kentucky Hospital Association, at $85,835. In 11th place was Altria Client Services, a cigarette company, at $73,309; it supported the successful bill to limit legal sales of vaping products to those approved by the U.S. Food and Drug Administration.

Ranking 17th was Elevance Health and Affiliates doing business as Anthem Inc., at $59,946. The health-insurance firm was followed by the Kentucky Medical Association, the main lobby for physicians, at $54,051, and the Kentucky Primary Care Association, a trade group for health clinics, at $49,416.

Overall, spending on legislative lobbying for the first three months of 2024 was a record of $9.719 million, the Ethics Commission reported Tuesday: "The previous record for the same period was $9.343 million, set last year; 933 businesses and organizations registered to lobby in Kentucky, spending $9.427 million; 727 lobbyists were paid $8.289 million in compensation, and also reported $291,942 in expenses."

Community pharmacies can help smokers quit, study finds

Photo illustration from QuitSmokingPharmacies.com

Kentucky Health News

Community pharmacies may play a key role in helping smokers quit, according to a study done in California and published in the peer-reviewed journal Pharmacy.

Kentucky' adult smoking rate, 17.4%, is tied for fourth in the nation with MIssissippi. For a partial list of pharmacies that advertise their help with smoking cessation, go to QuitSmokingPharmacies.com.

"Although two-thirds of people who smoke would like to quit, many individuals trying to quit on their own are not successful," notes a news release from the University of California, Davis, where the study was done in cooperation with  other academic institutions across the country and the Community Pharmacy Enhanced Services Network, involving 22 California pharmacists and 26 pharmacy technicians who underwent tobacco cessation training.

"Pharmacists have shown to be effective in helping patients quit," the release said. "They can reach uninsured and under-resourced patients as well as patients living in rural areas who might experience barriers to accessing primary care. However, the study showed certain barriers exist to making pharmacy cessation programs effective," such as billing complexities, software limitations and training gaps for handling complicated patient cases.

“Compatibility with existing workflows, staff buy-in and the crucial role of pharmacy technicians significantly helped” pharmacy custiomers quit smoking, said the study's senior author, Karen Hudmon of the Purdue University College of Pharmacy.

Database lists opioid-settlement payments to local governments

Screenshot of first page of KFF Health News database of settlement
payments in Kentucky through March 4 shows the top 15 recipients.

How much money are your local governments getting from the settlements of lawsuits filed against opioid manufacturers and distributors? You can track it with a new online database from KFF Health News.

Kentucky is getting $478 million from the settlements through 2038, and a like amount is being paid each year to local governments in the state. State government got $100.7 million in 2022 and $17.4 million in 2023. It will get $21.8 million this year and the same amount in 2025, and an average of $24 million a year after that.

The state's money is being allocated by the Kentucky Opioid Abatement Advisory Commission, operated out of the attorney general's office. Local governments' spending is up to their governing bodies.

"This database undercounts the amount of opioid settlement money most places have received and will receive," note Aneri Pattani and Lydia Zuraw and Holly K. Hacker of KFF Health News.

The database reflects only the largest settlement so far, $26 billion to be paid by pharmaceutical distributors AmerisourceBergen (now called Cencora), Cardinal Health, and McKesson, as well as opioid manufacturer Janssen (now known as Johnson & Johnson Innovative Medicine).

It does not include settlements with other drug manufacturers and retailers Walmart, Walgreens, and CVS. Data from these five companies will be added in July, according to BrownGreer, the settlement firm that gets the money and makes the payments. It is not handling some additional settlements such as the agreement between Kentucky and four Midwestern states with regional supermarket chain Meijer.

Other settlements, including with OxyContin manufacturer Purdue Pharma, are pending.

Bill to let pharmacists give vaccines to children 5 and older heads to governor's desk; 11 Senate Republicans vote against it

By Melissa Patrick
Kentucky Health News

A bill to allow Kentucky pharmacists to order and administer vaccinations to children down to the age of 5 has gained final passage, but only after several senators voiced their concerns about the bill and four of them changed their votes from "yes" to "no."

Since 2017, Kentucky pharmacists have been able to administer vaccinations to children as young as 9, and younger with an order from a health-care provider. The age was lowered to 3 during the Covid-19 public health emergency to help increase access to care, but that law is set to expire Oct. 1.

The original version of Rep. Danny Bentley's House Bill 274 would have allowed pharmacists to order and administer vaccinations to children as young as 3, with the consent of a parent or guardian, but this was increased to age 5 in a committee substitute to appease the Kentucky Medical Association.

State Sen. Stephen Meredith, R-Leitchfield
(Legislative photo from March 8, 2024) 

Sen. Stephen Meredith, who presented the bill to the Senate, lauded it as a way to "fix a problem," noting that Kentucky ranks lower than five of the seven surrounding states when it comes to childhood vaccinations.

"Kentucky is facing a public-health crisis in regard to childhood vaccinations," the Leitchfield Republican said. "It does not introduce any new vaccine mandates. It does not expand the scope of practice of pharmacy. It does not replace well-child checkups."

The Senate gave final passage to HB 274 on a vote of 26-11 on March 22. It will now go to Democratic Gov. Andy Beshear's desk for his signature or veto. 

Sen. Lindsey Tichenor, R-Smithfield, withdrew two floor amendments that she had filed, one to ban requiring students to get the Covid-19 vaccine for "enrollment, employment or medical treatment" and the other to require employers to offer religious or medical exemptions for vaccinations to all employees. 

(On the same day, Tichenor's Senate Bill 295, to prohibit the requirement of a Covid-19 vaccine for any individual for the purposes of student enrollment, participation in any school-based program or extracurricular activity, internship, acquiring or maintaining a professional license or receiving a health care services, was approved with a committee substitute by the Senate Health Services Committee on a vote of 8-2.)

The bill Meredith carried, HB 274, passing the House without dissent on March 5, ran into opposition in the Senate.

Sen. Adrienne Southworth, R-Lawrenceburg, voted no and said she was "baffled" about the discussion, arguing that there is no longer a need for pharmacists to administer vaccines to younger children because the public-health emergency is over.

"I know our pharmacists have been administering vaccines, when we're in a state of emergency," she said. " And we're done with emergencies. . . . Are pharmacists dispensing drugs or are they administering vaccines?"

Tichenor also voted no, voicing concerns that the bill allows pharmacists to give vaccines to a child without knowing their medical history: "I think it's a little bit reckless to be issuing out vaccines that do have potentials for bad adverse events, and to be opening a door where it can be easy or easier, more accessible with less oversight." 

Sen. Shelley Funke Frommeyer, R-Alexandria, questioned the safety of the additives in vaccines: "We are continuing to promote and advocate something that isn't actually [in] your control. It's now in the doctor's or the pharmacists," she said. "We must own our health. We must be committed to our children's health." 

Meredith lambasted his colleagues who voted against the bill, speaking to the challenges that people in rural Kentucky have when it comes to getting access to care. 

“It’s easy to assume that people have access to care, particularly rural Kentucky. It’s not there," he said. "What do they do if they don’t have it? . . . That’s very easy to say, ‘Just get in your car and drive a few miles up the road.’ If you think that way, then you don’t really understand rural Kentucky."

Meredith added, “If you’re voting against this based on principle, you’re cheating the children of Kentucky, particularly rural Kentucky. I can’t begin to tell you how disappointed I am in that.”

Other Republican senators voting against the bill were Floor Leader Damon Thayer of Georgetown, Tichenor, Johnnie Turner of Harlan, Stephen West of Paris and Gex Williams of Verona. Changing their vote from "yes" to "no" were Republicans Robby Mills of Henderson, John Schickel of Union, Brandon Smith of Hazard and Phillip Wheeler of Pikeville. 

Kentucky kids still playing vaccine catch-up

Access to routine vaccinations remains crucial, especially among kindergarteners, a group whose routine vaccinations seem to have been hit hardest by the pandemic.

In November, Kentucky Health News reported that uptake of the combined measles-mumps-rubella vaccine in the state increased in 2023, after three years of decline, but the remains below the national average and the level needed to protect the population from measles, a highly contagious disease that has cropped up in several states.

Most of the routine childhood vaccine rates for kindergarteners remain below pre-pandemic levels, according to the state Department for Public Health Kindergarten Immunizations Dashboard.

The Centers for Disease Control and Prevention offers a wealth of information about the safety of vaccinations and the American Academy of Pediatrics calls for the on-time, routine immunization of all children and adolescents "as the safest and most cost-effective way of preventing disease, disability and death," it says.

 
Kentucky's schools require students to provide up-to-date immunization records at the beginning of each school year, unless a student is exempted for religious or medical reasons.

Bill to let pharmacists give vaccines to children 5 years and older advances, as state struggles to catch up on child immunizations

By Melissa Patrick
Kentucky Health News

A bill to allow Kentucky pharmacists to order and administer vaccinations to children down to the age of 5 advanced out of committee unanimously. 

Brooke Hudspeth and Rep. Danny Bentley present House Bill 274
to the House Health Services Committee. (Photo by Melissa Patrick)

"This bill is for those counties without pediatricians," said the bill's sponsor, Rep. Danny Bentley, R-Russell (Greenup County). "And we know that most people are within five miles of the pharmacy." 

The House Health Services Committee approved House Bill 274 on Feb. 1, and the measure was posted for passage in the full House on Monday, Feb. 5. 

The original version of the bill would have allowed pharmacists to order and administer vaccinations to children as young as 3, with the consent of a parent or guardian, but this was increased to age 5 in a committee substitute to appease the Kentucky Medical Association. 

Dr. Donald Swikert, a family medicine doctor and KMA member, told Kentucky Health News that the KMA felt it was important to make sure children continued to go to their annual well-check physician visits through age four because those are really "key visits" and  "there's a lot that goes on other than vaccinations." 

Bentley, a pharmacist by trade, said he appreciated the work of the KMA on the bill, but also pointed out that 51 of the state's counties have no pediatrician. 

Since 2017, Kentucky pharmacists have been able to administer vaccinations to children as young as 9, and younger with an order from a health-care provider.  

The age was lowered to 3 during the Covid-19 public health emergency to help increase access to care, with legislation that is set to expire Oct. 1. 

Brooke Hudspeth, president of the Kentucky Pharmacists Association, told the committee that Bentley's bill would ensure continued access to care. 

"House Bill 274 simply codifies the practice that pharmacists across the state have been performing for the past four years, so that we can ensure continued access to care that children and their parents have come to expect," Hudspeth said. "Pharmacists are trained and educated to screen and administer immunizations to children and adults. . . .  Your constituents and our patients have come to rely upon access to immunizations at their local pharmacy." 

Bentley stressed that this bill is not a mandate and committee Chair Kim Moser, R-Taylor Mill, said she appreciated that aspect of the bill. 

“We want to make sure that children are protected from communicable diseases and vaccines have been proven to keep children safe,” Moser said. “It does increase the convenience factor for families and parents and ensures safety and … protection.”

Kentucky kids still playing vaccine catch-up

Access to routine vaccinations remains crucial, especially among kindergarteners, a group whose routine vaccinations seem to have been hit hardest by the pandemic.  

In November, Kentucky Health News reported that uptake of the combined measles-mumps-rubella vaccine increased last year, after three years of decline, but the state's rate remains below the national average, and below the level needed to protect the population from measles, a highly contagious disease. 

Most of the routine childhood vaccine rates for kindergarteners remain below pre-pandemic levels, according to the Kentucky Department for Public Health Kindergarten Immunizations Dashboard. 

Kentucky's schools require students to provide up-to-date immunization records at the beginning of each school year, unless exempted for religious or medical reasons.

Whipsawed by the system, dozens of independent pharmacies closed in Kentucky last year, and more are expected to follow suit

“No one can withstand this onslaught,” independent pharmacist Rosemary Smith of Beattyville told the Lexington Herald-Leader of the factors causing stores like hers to close. (H-L photo by Silas Walker)

Kentucky Health News

In the past year, at least 67 independent pharmacies have closed in Kentucky, and more are expected to close because of a recent change in the system that favors big pharmacy chains. 

So reports Alex Acquisto of the Lexington Herald-Leader, in a significant story for rural Kentucky. 

"Pharmacists are often the first – and most accessible – health-care-provider point of contact in their communities, particularly in rural parts of Kentucky," Acquisto writes. "Independent pharmacies in Kentucky filled more than half of all prescriptions statewide and before 2023’s closures, independents operated in all but one of the state’s 120 counties."

That's according to Rosemary Smith, who owns six pharmacies across Eastern Kentucky with her husband, Luther, and is co-founder of the Kentucky Independent Pharmacists Alliance. KIPA is seeking help from the Kentucky General Assembly, which has previously tried to insulate independent pharmacists from the middlemen between insurance companies and pharmacies, pharmacy benefit managers.

The sponsor of earlier bills aimed at PBMs, Sen. Max Wise, R-Campbellsville, told Acquisto that he will probably file a bill similar to the recent “commercial pharmacy PBM reform” bills in Tennessee and West Virginia. The Tennessee law "gives independent pharmacies greater control over the PBM contracts they agree to, including by mandating those groups reimburse no less than the actual cost for a prescription drug," Acquisto reports. "That is an aspect not currently mandated by law in Kentucky."

The system

Acquisto explains how it got this way: "Each time an independent pharmacist fills a patient’s prescription, how that pharmacy is reimbursed by insurance companies — and what amount in fees are levied for filling it — is decided by a somewhat arbitrary and complex tangle of decisions by entities outside a hometown pharmacy’s control. This lack of control and contractual obligation to pay every fee levied has paved the way for independents to be financially gouged from multiple angles: Low or break-even reimbursement rates set by insurance companies often blunts a pharmacy’s ability to make a profit on every prescription they fill."

Pharmacy benefit managers charge pharmacies direct and indirect remuneration fees. "Federal regulations have historically dictated these fees be collected retroactively, up to six months after a prescription is filled. But that changed Jan. 1, when DIR fees began to be collected at the point of sale," Acquisto reports. "Pharmacists told the Herald-Leader they expect this temporary overlap, where DIR fees from as far back as June 2023 continue to be retroactively deducted as new fees are levied on prescriptions filled currently, will inevitably force more closures."

“This increase in DIR fees has resulted in many independent pharmacies being left with little to no capital funds to survive 2024,” Maysville druggists Dr. Michael Berry and Elizabeth Berry wrote in a Dec. 31 email to Chiquita Brooks-LaSure, adminstrator of the Centers for Medicare and Medicaid Services. “Most independent pharmacies have been on life support for the last several years. We are witnessing the initial stages of an industry in collapse.”

Medicaid change that saved money being used for expanded benefits has also been a lifeline for many independent pharmacies

Joel Thornbury gets a flu shot at his Pikeville pharmacy.

By Deborah Yetter
Kentucky Lantern

Pharmacist Joel Thornbury said his role is far more than filling prescriptions at the Nova Pharmacy he owns in Pikeville; he’s a readily accessible source of health services and advice in his community.

“When you call me, you get me,” said Thornbury, a third-generation pharmacist for more than 30 years. “I see you on the street. I’m not some big corporation.”

And Thornbury said his job has become far more manageable, following the state’s decision in 2020 to eliminate multiple corporate middlemen that previously managed the state’s Medicaid prescription drug business and took a cut of the proceeds.

“It’s phenomenal,” Thornbury said of the state’s decision to cut out the brokers known as pharmacy benefit managers. PBMs are private entities that work as subcontractors to health plans and decide how much to pay pharmacies and which drugs to cover.

“You just make my life easier and cut down on the number of people I have to talk within the insurance industry,” Thornbury said.

What’s more, it’s saving the state money — a lot of money — by putting Medicaid prescription management under single vendor, Medicaid officials recently told a state legislative committee. And that has enabled expansion of Medicaid benefits, though that has been in a political wrangle.

Savings since the change took effect in 2021 amount to about $283 million through 2022, $56.6 million of that in state money, officials told the committee. The rest is savings to the federal government, which pays most of the costs of the federal-state health plan that covers one in three Kentuckians.

Medicaid, with annual expenditures of about $15 billion, is Kentucky’s largest health plan and a major source of income for health providers including hospitals, doctors and pharmacies. It spends about $1.2 billion a year on prescription drugs.

The elimination of outside PBMs brought dire warnings of soaring costs from companies that previously managed Medicaid’s prescription drug business and claimed to keep down expenses. But a state analysis found the opposite, state Medicaid officials Veronica Judy-Cecil and Steve Bechtel told the legislative Health Services Committee on Sept. 27.

The state has plowed some of its savings back into this year’s expansion of Medicaid dental, vision and hearing benefits for adults, Cecil said. Advocates have said the expanded benefits, especially in dental care, are sorely needed in a state that ranks 49th in oral health.

But the expansion has been controversial with Republicans who control the legislature and say Gov. Andy Beshear, a Democrat, exceeded his authority by enacting them.

Max Wise (Photo by Ryan C. Hermens, Lexington Herald-Leader)

However, legislators recently passed up a chance to start repealing the expansion, and they are delighted with the savings that resulted from they legislation they enacted to abolish their role.

“Today’s a great day for the Commonwealth of Kentucky,” said Sen. Max Wise, R-Campbellsville, during the legislative committee meeting. Wise sponsored Senate Bill 50, the 2020 law that ended Medicaid work for the six PBMs.

“SB 50 truly saved jobs,” Wise said. “It kept a lot of pharmacies open.”

Committee co-chair Sen. Steve Meredith, R-Leitchfield, who has been highly critical of the PBMs’ role in Medicaid, recalled warnings from national insurance companies that previously held the contracts, including Caremark, an affiliate of the CVS drugstore giant. Many PBMs are affiliated with pharmacy chains.

Caremark, after the bill won final passage in 2020, issued a statement warning eliminating PBMs would cost Kentucky millions of dollars in increased prescription drug expenses.

“It’s going to cost our Medicaid program more?” Meredith said, recalling the warning. “Obviously, that’s not the case.”

Benjamin Mudd, executive director of the Kentucky Pharmacists Association, said the changes have been enormously popular with the state’s pharmacists.

“I think it’s been a phenomenal experience for everyone involved except maybe the PBMs,” Mudd said. “I would say Senate Bill 50 has undoubtedly kept some pharmacies from closing in our state.”

‘Squeeze and buy’

Independent community pharmacists became increasingly critical of PBMs in the years since 2011 when the state switched most of its Medicaid business to outside managed-care organizations, or MCOs — mostly subsidiaries of private insurance companies — to handle Medicaid claims.

In turn, the MCOs hired PBMs as subcontractors to manage pharmacy benefits.

That led to vocal complaints from pharmacists that aggressive cost-cutting by PBMs were threatening their business. Meanwhile, PBMs charged higher rates to state Medicaid programs and kept the difference as profit, a practice known as “spread pricing,” critics told Kentucky lawmakers.

Another problem: Because Kentucky currently contracts with six MCOs, pharmacists had to deal with six separate PBMs for reimbursement and six lists of drugs they would cover.

Thornbury's pharmacy in Pikeville (Photos provided)

That added to frustration, extra work and costs, said pharmacists including Pikeville’s Thornbury, who said the extra layers of seeking approval and payment for drugs was maddening.

“It’s a gigantic shell game,” he said.

Pharmacies foundering financially were often met with offers from pharmacy chains to buy their business. It especially hurt small, community pharmacies, the owners said.

“I just call it ‘squeeze and buy,’” Rosemary Smith, an independent pharmacist from Eastern Kentucky told legislators in 2018. “They are trying to put us out of business.”

About 500 of Kentucky’s 1,300-plus drugstores are independently owned.

Meanwhile, lawmakers found it deeply frustrating that state Medicaid officials had virtually no control over the PBMs because they reported to the MCOs that hired them rather than the state.

Complaints, mostly from their hometown pharmacists, resonated with lawmakers even as PBMs were facing scrutiny and new restrictions in other state Medicaid programs including West Virginia and Ohio.

After several years of investigations and review, the General Assembly enacted Wise’s SB 50, which eliminated the role of PBMs as subcontractors in the state Medicaid program.

Instead, it directed the state to hire a single PBM to report to the state Medicaid program, giving it more control over reimbursement to pharmacists and ability to more quickly work out any problems, questions or delays.

“It’s much easier for us to work through a single entity,” Thornbury said. “I call one location. If I have a problem, I call one person.”

The change also created one list of approved drugs, meaning pharmacists now can determine immediately which drugs are approved for all Medicaid members. And it eliminated the “spread pricing” critics said enriched PBMs at pharmacists’ expense.

‘Smooth transition’

Judy-Cecil, the Medicaid deputy commissioner, said Kentucky launched its new system in July 2021 and hired MedImpact, an independent PBM not affiliated with any pharmacy chain, to do the work.

Benjamin Mudd

“I believe it was a very smooth transition,” she said. The Medicaid department expects to release a report soon with more details on the impact of the changes and savings.

Another benefit to pharmacists: SB 50 set a base reimbursement model in which pharmacists get a $10.64 dispensing fee plus the costs of the medication.

Previously, pharmacists had no such guarantee and could end up barely breaking even or losing money on prescriptions they dispensed, Mudd said.

“Stores that were facing closure or were right on the fence. . . that little bump may have helped them stay open,” Mudd said.

That doesn’t mean the outlook is rosy for pharmacists, Mudd and others said.

They are still facing cost pressures from commercial insurance and Medicare. And a handful have closed or sold their businesses, Mudd said.

But changes of the last two years offered a much-needed lifeline, he said.

“Without a doubt, a much larger number of pharmacies would have closed if it weren’t for Senate Bill 50,” he said.

Meanwhile, lawmakers say they will continue to examine the role of PBMs in other health coverage, including the state employee health plan.

And Meredith, a former hospital CEO who has long complained the state’s six MCOs are too many — adding to complication, cost and confusion — threw out this idea:

“If we went from six PBMs to one and we save money, do you think there’s any potential to save money if we have fewer MCOs?” he asked. “Just a rhetorical question.”

U.S. Senate panel OKs bill to rein in pharmacy benefit managers; Kentucky pharmacist applauds similar efforts by House members

By Melissa Patrick

Kentucky Health News

At least one Kentucky pharmacist is applauding the latest efforts to rein in pharmacy benefit managers.

PBMs are middlemen that negotiate drug prices with drug manufacturers and pharmacies. They also design prescription-drug benefits for health plans.  

Taylor Williams

"Fortunately, lawmakers are hearing our concerns loud and clear," Taylor Williams, a second-generation pharmacist from Hazard and an executive fellow with the Kentucky Pharmacists Association, wrote in an op-ed submitted to  Kentucky Health News and other publications.

"Congressman Brett Guthrie, chair of the Health Subcommittee on House Energy and Commerce, and Congressman James Comer, chair of the house Oversight Committee, are working hard to rein in PBMs’ profit-driven role in our healthcare system and ensure that patients can afford the prescriptions they rely on," she wrote.

Williams submitted the op-ed on the same day the Senate Finance Committee advanced a bipartisan bill to change how PBMs interact with federal prescription-drug programs as a way to help lower costs.  It is called the Modernizing and Ensuring PBM Accountability Act. 

The Hill reports, "While other committees have also passed PBM reform bills, the Finance Committee has jurisdiction over Medicare and Medicaid, which make up a large portion of U.S. health spending. Still, all the separate bills in the House and Senate will need to be combined into one floor-friendly package." 

Among other things, the Senate bill includes provisions that would delink PBMs' compensation from drug prices, which would remove an incentive for PBMs to favor higher-priced drugs. It would also add new transparency and reporting requirements and ban spread pricing, in which a PBM keeps the difference between what it bills Medicaid for medications and what it pays the pharmacy to dispense the drug. Click here for a summary of the Act. 

Kentucky lawmakers have been working on PBM issues for years, most recently passing 2020 Senate Bill 50 that among other things, prohibits spread pricing. A 2019 state analysis found PBMs made $123 million through spread pricing in Kentucky.

SB 50 also required the state to hire a single PBM to manage Kentucky Medicaid's prescription-drug business of more than $1 billion a year. Kentucky has saved at least $38 million from this move. 

This year, companion PBM bills were introduced in the state House and Senate, but neither got a hearing.

PBMs argue that they lower costs for consumers because they negotiate for lower drug costs and pass the savings onto to the insurance plans. 

Williams said she recently met with Kentucky's congressional delegation in Washington to share her concerns about PBMs and their impact on Kentucky's independent pharmacies and the patients they serve. 

"Our profession is facing serious challenges because of largely unknown middlemen in the drug pricing system called pharmacy benefit managers," she wrote. "If we don’t do something about them soon, the local community pharmacies that people trust may become a thing of the past. . . . Without much needed reform, PBMs will continue to find new ways to increase their profit margins at the expense of patients, providers and taxpayers. Even worse, it could leave Kentuckians without a local, trusted health-care advisor as many community pharmacies will be forced to close their doors." 

FDA expands availability of abortion-inducing medication

Women who want to use a pill to end their pregnancy in the first 10 weeks will now be able to get it directly from health-care providers and pharmacies. The move by the U.S. Food and Drug Administration expands options for women in Kentucky, where almost all abortions are currently illegal. The state Supreme Court, in a pending case, could change that.

The FDA announced the new rules for the abortion-inducing drug mifepristone Tuesday night. The drug is already used in more than half of the abortions in the United States.

"Prior to this announcement, mifepristone could only be dispensed by some mail-order pharmacies, or in person by specially certified providers," MedPage Today notes. "This week's decision will allow patients to pick up the abortion pill at brick-and-mortar locations, including local drugstores or chain pharmacies like CVS or Walgreens." Those chains said they would sell the drug. Rite Aid said it was reviewing the FDA's action, USA Today reports.

Last year, the FDA allowed the drug to be obtained by mail, but the Kentucky General Assembly banned that in a wide-ranging anti-abortion bill. FDA proposed the changes in December 2021, "six months before the Supreme Court overturned Roe v. Wade and left abortion policy up to individual states," notes Beth Wang of Inside Health Policy. In Kentucky, the decision activated a "trigger law" that bans abortion except to save the woman's life.

The changes announced Tuesday allow pharmacies that go through a certification process, still not specified, to dispense the drug directly to patients who have a prescription from a certified prescriber who has an agreement with the certified pharmacy, Wang reports.

UPDATE, Jan. 5: "Legal scholars slammed FDA’s certification requirements for pharmacies to dispense the abortion pill, mifepristone, saying they’re unnecessary and not based in science, and the experts called on FDA to get rid of the prescribing and dispensing restrictions altogether," Wang reports.

"FDA also has permanently removed the requirement that patients see a health-care provider in person before being prescribed the drug," Wang notes. "That requirement was temporarily removed during the Covid-19 public health emergency." However, Kentucky law bans the use of telemedicine to get a mifepristone prescription.

Colorectal screening now available at participating Ky. pharmacies

L-R: Brooke Sorgi of Exact Sciences, maker of Cologuard, a

DNA-based screening test, and Capital Pharmacy pharmacist

Dr. Emily Wilkerson mark the first pharmacist-led colorectal

cancer screening via a stool-based test on Sept. 29.

Kentucky's pharmacists and health insurers have teamed up to offer what they say is the nation's first "pharmacist-led colorectal cancer screening via a non-invasive stool-based test."

The test was done Sept. 29 at Capital Pharmacy & Medical Equipment in Frankfort, the Kentucky Pharmacists Association and the Kentucky Association of Health Plans said in a Nov. 17 news release.

“Health plans and pharmacists are joining together to tackle a leading cause of death in the commonwealth,” KAHP Executive Director Tom Stephens said.

KAHP gave the Kentucky Pharmacists Education and Research Foundation a $50,000 grant to expand access to these screenings in Kentucky. Participating pharmacies are being reimbursed for pharmacist-led screening and follow-up.  

KPA Executive Director Ben Mudd said, “Adding assessment of and screening for colorectal cancer to existing pharmacy protocols can greatly impact our two-decade-long fight to increase CRC screening rates. With early detection, colorectal cancer is a preventable, treatable, and beatable disease.”

The screenings were authorized by a new protocol approved by the Kentucky Board of Pharmacy in September 2021. It lets pharmacists initiate dispensing of noninvasive, stool-based colorectal cancer screening such as a fecal immunochemical test or a stool DNA test. Pharmacies interested in providing the service can contact Dr. Emily Wilkerson at fellow@kphanet.org for more information.

Latest bill to aid independent pharmacies stalls in Senate after running into one of the session's heaviest lobbying campaigns

By Melissa Patrick
Kentucky Health News

FRANKFORT – The latest bill to help independent pharmacies compete with pharmacy benefit managers sailed out of the House with overwhelming support but came to a resounding halt in the Senate. No one is saying why, but the PBMs mounted one of the session's heaviest lobbying campaigns.

PBMs determine what drugs are offered in insurance plans, where and how a patient gets their drugs, how much is paid for the drug, and how much the pharmacist gets. The leading PBM in Kentucky is CVS Caremark, a sister company to one of the nation's largest pharmacy chains.

House Bill 457 passed the House 88-3 on March 21, with 56 sponsors. The next day it went to the Senate Appropriations and Revenue Committee, not a usual location for such a bill, and never got a hearing. It has had none of its regularly required three daily readings, and only two legislative days remain. 

Key parts of the bill would ensure that patients could pick their pharmacy, instead of being required to use one affiliated with the PBM; increase transparency between insurers and PBMs; and ban PBMs from retroactively denying a pharmacy claim after adjudication, commonly referred to as "clawing back." Opponents say the bill would raise costs for consumers.

Rep. Steve Sheldon, R-Bowling Green

Republican Rep. Steve Sheldon of Bowling Green, the bill's prime sponsor, said he was surprised that it didn't move in the Senate after getting such overwhelming support in the House. He said he couldn't say why leaders of the Senate's Republican majority had not supported it, but did say that many big companies opposed it. 

Those companies' heavy lobbying efforts appear to have worked. 

The Pharmaceutical Care Management Association, PBMs' trade group, was one of the state's top 10 lobbying spenders in the first two months of the legislative session, spending $38,369 to get their messages to lawmakers, according to reports they filed with the Kentucky Legislative Ethics Commission.

That ranked the PCMA ninth in spending, and it seems likely to end the session at a higher rank, because it spent thousands of dollars from March 21 to April 1 on television commercials asking viewers to contact their legislators and ask them to vote against HB 457, saying it would raise drug prices.

Sheldon fought back on his Facebook page March 28, pleading with senators to consider the bill.

"I would appreciate the Senate looking at HB 457," he said. "We are down to 2-3 days … I realize bills that inject millions back into Kentucky and allow our seniors patient choice are not as glamorous as the status quo, but please take a real close look at this. Don’t let your Kentucky dollars get mandated by PBMs out of state while our seniors wait by the mailbox for their medicine !! Don’t believe the lies, propaganda and rhetoric. It’s not TOO late." 

The only group that appeared to spend money lobbying in favor of the bill through February was EPIC Pharmacies, a nonprofit buying group for independent pharmacies, which reported spending $7,416. Lobbying groups' spending reports for March are due April 15.

CVS Health reported spending $21,528 through February. In a statement dated March 21, it said, "House Bill 457 will only increase the costs of prescription drugs in Kentucky, making it more difficult for Kentuckians to access affordable medications. Dozens of Kentucky employers are opposed to this bill because it does not help control the cost of prescription drugs and hurts their employees. We urge the Senate to reject HB 457. We should protect consumers from increased health care costs, and lawmakers should focus on the high prices set by big drug companies."

The Kentucky Association of Health Plans, comprising companies selling health insurance in the state, reported spending $11,316 on legislative lobbying through February, and the Kentucky Association of Health Underwriters reported spending $5,000. Both spoke against the bill in a House committee. 

Individual insurance companies, which have a wide range of interests, also opposed the bill. Anthem Inc. and its affiliates reported spending $35,597 on lobbying in the first two months, ranking 11th; United Healthcare reported spending $14,000.

Senate Appropriations and Revenue Committee Chair Sen. Chris McDaniel, R-Ryland Heights, did not respond to several e-mails from Kentucky Health News asking why he did not give the bill a hearting. 

Angela Billings, spokeswoman for the Senate majority, said in an e-mail that she had reached out to McDaniel with the question and that it would have to be "tabled" until the General Assembly returns April 13 to reconsider bills and budget lines vetoed by Gov. Andy Beshear.

"I daresay that he was extraordinarily busy with the budget and could not get to many bills worthy of hearing," Billings said. 

Sen. Max Wise, R-Campbellsville, who has been instrumental in getting PBM-control bills passed in prior legislative sessions, said he didn't know why this one hadn't moved in the Senate, but said in a text message, "I do support the concept and the language of HB 457." Asked if it was discussed in Republican senators' private caucus, he said, "Policy discussions stay within the caucus."

Kentucky lawmakers have been working on PBM issues for years, most recently passing 2020 Senate Bill 50 to make the state hire a single PBM to manage Kentucky Medicaid's prescription-drug business of more than $1 billion a year. A 2019 state analysis found PBMs made $123 million through spread pricing.

During the bill's House hearing, Sheldon, a pharmacist and businessman who is not seeking re-election, said it had taken three years of collaboration to produce, with upwards of 20 organizations supporting it. Not all of them lobby.

Lobbying groups must list the bills on which they are lobbying, but not whether they are for or against them. Other than those above, those that listed HB 457, and their total expenses between Jan. 1 and Feb. 28, were: American Pharmacy Services Corp., $550; Appalachian Regional Healthcare, $10,209; Chewy Inc., $10,000; Ford Motor Co., $17,500; GE Appliances, $5,000; St. Elizabeth Healthcare of Northern Kentucky, 16,358; and University of Louisville Health, $6,000.

Latest bill to aid independent pharmacies passes first hurdle; would ban requiring or incentivizing patients to use mail order

UPDATE: On March 21, HB 457 was sent to the Senate on an 88-3 vote. 

By Melissa Patrick
Kentucky Health News

Many Kentucky lawmakers keep siding with independent pharmacies against pharmacy benefit managers, the insurance middlemen between pharmacies and drug makers. Thursday a committee approved a bill to ban requiring patients to use mail-order pharmacies or using incentives for mail order.

Rep. Steve Sheldon

"This is truly about the consumer," Rep. Steve Sheldon, R-Bowling Green, told the House Health and Family Services Committee while presenting House Bill 457. Besides Sheldon, who is a pharmacist by trade, its sponsors include 55 of the 100 House members.

Pharmacy benefit managers determine what drugs are offered in insurance plans, where and how a patient gets their drugs, how much someone pays for the drug, and how much the pharmacists are paid. 

Sheldon's bill would also ensure that patients can pick their pharmacy, instead of being required to use one affiliated with the PBM, and ban PBMs from retroactively denying a pharmacy claim after adjudication, a process commonly referred to as "clawing back."  

Sheldon said it had taken three years of collaboration to produce this bill, with upwards of 20 organizations supporting it. 

"I'm a legislator. I'm a pharmacist, I serve as a division CEO for a very large self-insured company with several thousand employees, so I'm very sensitive to that issue and how this could affect that. I'm convinced I'm doing what's right for every single one of those," he said, adding that it also addresses the issues for consumers. "I feel like this addresses all four."

The bill also includes language to increase transparency between insurers and PBMs and would halt the a practice of "white bagging," 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. 

Kentucky lawmakers have been working on PBM issues for years, most recently passing 2020 Senate Bill 50 to require the state to hire a single PBM to manage Kentucky Medicaid's prescription-drug business of more than $1 billion a year. A 2019 state analysis found PBMs made $123 million through spread pricing.

Kentucky Pharmacists Association President Cathy Hanna said Sheldon's bill would "ensure Kentuckians have safe, reliable access to the brick-and-mortar community pharmacy of their choice," adding that rural pharmacists "are often the most direct and trusted provider contact for many individuals and families." 

Hanna said requiring patients to get their drugs through mail-order or at a specific PBM-owned pharmacy has contributed to the closing of community pharmacies, saying four have closed in the past month. She cited a recent Public Policy Polling survey that found 84% of respondents did not support mandated mail order.

On the other side of the argument in committee were lobbying groups for PBMs, insurers and some employers.

Conner Rose of the Pharmaceutical Care Management Association, the PBM lobby, said PBMs strive to make drugs affordable and the bill could increase costs. For example, he said employers support "white bagging" because PBMs can provide these expensive drugs at less cost than a provider's office.

“HB 457 continues to include provisions that restrict PBM cost saving tools and therefore will increase prescription drug costs by $213 million in the first year alone," Rose said in an e-mail. 

Frank Jemley, executive director of the Kentucky Association of Manufacturers, expressed concern that the bill would increase health-care costs for Kentucky businesses and manufacturers.  

Scott Brinkman, a former House member and Cabinet secretary representing the Kentucky Association of Health Plans, targeted the contract portion of the bill: "It is invariably a very tricky proposition when government through legislation defines the terms of a contract between two private entities." 

KAHP executive director Tom Stephens said in a statement after the meeting, “I think it’s fair to say that if this government-mandated prescription-drug price-hike bill is passed, the General Assembly will be directly responsible for pricing many Kentuckians out of the market” by removing “cost containment measures that keep health coverage and prescriptions affordable.”

As for community pharmacies, Stephens said, “It’s a solution in search of a problem because Kentucky is in the top five in the nation when it comes to concentration of independent pharmacies.”

Mindy Farnsley, president of the Kentucky Association of Health Underwriters, said the bill "does nothing to address the cost of prescription drugs," would disrupt the health insurance market, and increase employer and consumer premiums.

But the Pharmacists Association said, "The committee's passage of HB 457 brings us one step closer to meaningful reforms that will put an end to PBMs' profit-driven practices that threaten the patient-pharmacist relationship."

Independent pharmacies are closing, leaving many in 'drugstore deserts'; 2020 Ky. law insulates them from predatory competition

Map adapted by Kentucky Health News

"Corner pharmacies, once widespread in large cities and rural hamlets alike, are disappearing from many areas of the country, leaving an estimated 41 million Americans in what are known as drugstore deserts, without easy access to pharmacies," Markian Hawryluk reports for The Washington Post. 

"An analysis by GoodRx, an online drug-price-comparison tool, found that 12 percent of Americans have to drive more than 15 minutes to reach the closest pharmacy or don’t have enough pharmacies nearby to meet demand. That includes majorities of people in more than 40 percent of counties."

Independent pharmacies are struggling to compete with chains whose relationships with insurers and pharmaceutical benefit managers give them a competitive edge. "Insurers also have ratcheted down what they will pay for prescription drugs, squeezing margins to levels that pharmacists call unsustainable," Hawryluk reports. "As the insurers’ drug plans steered patients to their affiliated drugstores, independent shops watched their customers drift away. They find themselves at the mercy of pharmaceutical middlemen, who claw back pharmacy revenue through retroactive fees and aggressive audits, leaving local pharmacists unsure if they’ll end the year in the black."

In 2020, Kentucky lawmakers passed Senate Bill 50, sponsored by Sen. Max Wise, R-Campbellsville, to deal with some of these issues, which Kentucky pharmacists have long said are so bad they are putting some of the state's drugstores out of business. 

The law requires the state to hire a single pharmacy benefit manager to manage the $1.7 billion-a-year prescription drug business of Kentucky Medicaid, which covers about a third of the state's population. It also established a single preferred drug list, or formulary, for all of the state's Medicaid managed-care organizations and put the state Department for Medicaid Services in charge of the reimbursement methodologies, including dispensing fees.

Further, the law requires the PBM to pay the managed-care firm the actual discounted pharmacy price negotiated with the pharmacy network and prohibits spread pricing, in which a PBM keeps the difference between what it bills Medicaid for medications and what it pays the pharmacy to dispense the drug. It also prohibits a whole list of fees and prohibits PBMs from taking retaliatory actions against pharmacies, among other things. 

A 2019 state analysis called “Opening the Black Box” found that the PBMs made $123 million through spread pricing.

Those pressures have whittled away at the number of independent pharmacies. "From 2003 to 2018, 1,231 of the nation’s 7,624 independent rural pharmacies closed, according to the University of Iowa’s Rural Policy Research Institute, leaving 630 communities with no independent or chain retail drugstore," Hawryluk reports.

Click here for the interactive map that shows the percent of county's population living more than 15 minutes from the three closest pharmacies.

UPDATE, Nov. 16: A study for the PBMs' trade group, by two Penn State professors, found that the number of independent pharmacies in the U.S. increased 12.9% from 2010 to 2019, while the number of chain pharmacies decreased 0.2%. In Kentucky, the number of independents increased 11.8%, to 557.

UPDATE, Nov. 18: "CVS Health announced Thursday morning that the company plans to close 900 stores nationwide over the next three years because of what executives described as changes in consumer shopping behavior, population, and the future of health care needs," The Boston Globe reports.

General Assembly has passed more than 35 health bills; several more could get passed, and a few are dead until next year

By Melissa Patrick

Kentucky Health News

Kentucky legislators have passed more than 35 health-related bills, addressing a range of topics such as health departments and pensions, substance-use disorder, immunizations, insurance co-payments and Alzheimer's disease. 

The bills now await Gov. Andy Beshear's signature or veto, he has already signed a few into law. Legislators can pass more bills when they wrap up the 2021 legislative session March 29 and 30, but they will be subject to a veto without the opportunity for an legislative override.

Here's a roundup of some of the health bills that have passed: 

Substance-use disorder: HB 219, sponsored by Rep. Danny Bentley, R-Russell, allows pharmacies to sell hypodermic syringes and needles without a prescription. This change was made to increase access to clean supplies for people who inject drugs, which will help to decrease the risk of blood-born diseases like hepatitis C and  HIV/AIDS. 

HB 219 would repeal requirements for pharmacies to keep records of sales of syringes and needles and allow their sale without a prescription, with a limit of 30 of each and proof that the purchaser is 16 or older. It would require pharmacies offering syringes and needles to provide educational materials on their safe and proper disposal, and referral information for syringe exchange programs and treatment of substance-use-disorder; and to offer naloxone, which is used to reverse opioid overdoses. 

The bill also allows for a specific-type of off-site pharmacy-related work that does not involve any dispensing.

Diabetes: HB 95, sponsored by Bentley, would cap the monthly out-of-pocket cost for a 30-day supply of insulin at $30 for Kentuckians covered by state-regulated health plans. The price cap would apply regardless of the amount or type of insulin the person with diabetes needs.

Health departments: HB 8, sponsored by Rep. Jim DuPlessis, R- Elizabethtown, would have quasi-governmental entities, including health departments, pay only what the Kentucky Retirement Systems needs to cover their employees' pensions instead of using the current "percentage of pay" formula. The effect on individual health departments varies widely.

Immunizations: Senate Bill 8, sponsored by Sen. Mike Wilson, R-Bowling Green, would allow several exemptions for "any child or adult" who doesn't want to receive a vaccine that the state mandates during an epidemic, including religious grounds, medical reasons or a "conscientiously held belief."

Drivers' sight: HB 439, by Rep. Kim Moser, R-Taylor Mill, would require a vision screening test be taken for renewal of a driver's license. Drivers could be screened at the renewal office or a medical office. 

Insurance: SB 55, sponsored by Sen. Stephen Meredith, R-Leitchfield, would get rid of all co-payments required by Medicaid.

SB 45, sponsored by Sen. Ralph Alvarado, R-Winchester, would limit the use of copay-accumulator programs by health plans, which prevent cost-sharing amounts paid on behalf of enrollees from counting towards their maximum out-of-pocket limits. 

SB 44, sponsored by Alvarado, ensures that any insurance payments made on behalf of an individual by a nonprofit organization are counted just as if the patient made it themselves. 

The Senate agreed to House changes in SB 44 that give providers until 2025 to tell women whose X-ray mammograms show dense breast tissue that such tissue is not abnormal, but slightly increases the risk for developing breast cancer. Providers are also asked to encourage "digital mammography" which provides a three-dimensional image of the breast. It also agreed to House changes that make sure the insured is responsible for payment, even if it is made by someone else, and prevent providers from paying premiums for their patients.

HB 48, sponsored by Bentley, a retired pharmacist, would allow pharmacists to be reimbursed by commercial insurance for providing medical care that other providers typically bill for, such as rapid flu tests, smoking cessation counseling or immunizations. Beshear signed the bill March 18. 

Telehealth: HB140, sponsored by Rep. Deanna Frazier, R-Richmond, would permit telehealth services that were allowed to expand due to the pandemic to remain in place after it ends. A key part of the bill would continue to allow audio-only visits, which is important because the state has many places without high-speed internet and many patients who are not adept at using technology.

Organ donation: HB 75, sponsored by Rep. Shawn McPherson, R-Scottsville, would keep insurance companies from increasing rates on organ donors or dropping their coverage. It would also encourage the cabinet to develop educational materials relating to organ donation. 

SB 12, sponsored by Alvarado, would prohibit a person from selling or purchasing human organs or tissue and ban for-profit entities from procuring any eye, cornea, eye tissue, or corneal tissue.

Alzheimer's disease: SB 61, by Meredith, would require six hours of dementia-specific training and three hours of annual continuing education for home-health aides and personal-service aides who provide care for Alzheimer’s or dementia, an often frustrating line of work with a very heavy turnover.

SB 74, by Alvarado, would establish but not fund a dementia services coordinator in the Cabinet for Health and Family Services to manage the Alzheimer’s Disease and Related Disorders Council, be in charge of the state plan to address Alzheimer’s in Kentucky and apply for federal funding opportunities.

Colon cancer: SB 16, by Alvarado, addresses several issues related to the screening program, including adding "prevention" to its name and requiring the Department of Medicaid Services to compile and present annual statistics on services related to colorectal cancer. 

Beshear had already signed HB 108, sponsored by Melinda Gibbons Prunty, R-Belton (Muhlenberg County) into law. It codifies existing Medicaid coverage of colorectal cancer, which includes screenings starting at age 45 for most people and genetic cancer-risk testing for the disease, to ensure uniform coverage for Medicaid patients that lines up with commercial-plan requirements. 

Infants and new mothers: HB 155, sponsored by Rep. Nancy Tate, R-Brandenburg, would allow the use of a “newborn safety device” to aid the anonymous surrendering of a newborn infant at a participating hospital, police station or staffed fire station. 

HB 212, sponsored by Samara Heavrin, R-Leitchfield, would require data in an annual state report on fatalities among children and new mothers to include information on demographics, race, income and geography associated with the fatalities. 

Mental health: HB 50, by Moser, would make health-insurance plans comply with a 2008 federal law that requires them to treat mental-health conditions and substance-use disorders just like physical conditions and file annual reports to show how they are complying. Beshear signed this bill March 12. 

Several health bills could still pass

HB 556, sponsored by Bentley, would allocate $20 million to a rural hospital operations and facilities loan fund created but not funded in the 2020 session. The bill has received two of the required three readings in the Senate and is in the Appropriations and Revenue Committee.

SB 51, by Alvarado, would ban the requirement of prior authorization for any prescription drug that is used in the treatment of alcoholism or opioid-use disorder and that contains methadone, buprenorphine or Naltrexone, or that is approved by the U.S. Food and Drug Administration for the mitigation of opioid withdrawal symptoms. It awaits a House floor vote. 

HB 91, sponsored by Rep. Joseph Fischer, R-Fort Thomas, would add to the state constitution a statement that it does not secure or protect a right to abortion or funding of abortion. The bill has had two readings and is in the Senate Rules Committee awaiting a floor vote. If passed, it would go on the ballot for voters to consider in November 2022. Governors don't act on constitutional amendments.

Health bills that are dead

SB 81, sponsored by Republican Caucus Chair Julie Raque Adams of Louisville, and HB  147, by Moser, would have restored local government control over use, display, sale and distribution of tobacco or vapor products. Neither was assigned to a committee, though Moser is chair of the House Health and Family Services Committee. Advocates of the bill said it had the votes to pass. 

SB 78, sponsored by Adams and Sen. Paul Hornback, R-Shelbyville, would have permanently removed the required collaborative agreements for prescriptive authority of controlled substances between a physician and an advanced practice registered nurse, and upon approval of the Kentucky Board of Nursing. The bill got out of committee, but wasn't called for a floor vote. 

Rep. Jerry Miller, R-Eastwood, tried to add SB 78's language as a floor amendment to SB 166. He ended up withdrawing it because it was deemed to not be germane, but made a floor speech about the importance of getting this legislation passed in the next legislative session.

After noting that this is the fourth year the legislation has been filed, and that he knew 70 of the 100 House members would have voted for it, Miller said, "This is a bill that's time has come. . . . APRNs are the general practitioners of the 21st century and we need to give them greater authority." 

SB 83, sponsored by Meredith, would have let medical professionals refuse to perform procedures that violate their religious or moral beliefs. It got out of committee, but was never called up for a floor vote. Meredith filed a similar bill in the 2020 legislative session that did not pass.

Health bills dealing with insulin cost, substance-use disorder and long-term-care staffing pass legislative chambers Tuesday

By Melissa Patrick
Kentucky Health News

Health-related bills are on the move in the General Assembly, with several of them passing out of their respective chambers Tuesday. 

House bills sent to the Senate include one that would help some Kentuckians with diabetes pay for their life-saving medication, another aimed at decreasing the stigma around getting syringes and needles in drug stores, and one related to temporary nurse aides.  

The Senate bill now in the House would remove prior-authorization requirements from drugs that help people who have a substance-use disorder deal with their addictions. 

Rep. Danny Bentley (LRC photo)

House Bill 95, sponsored by Rep. Danny Bentley, R-Russell, would cap the cost-sharing requirements for prescription insulin at $30 per 30-day supply for state-regulated health plans. The bill does not include Medicaid, Medicare or self-insured government plans.

Bentley, who is a Type I diabetic, said it is important for this bill to pass because many Kentuckians have to make a regular choice between paying their rent or buying their insulin. 

He explained that the cost of insulin has tripled between 2002 and 2013, even though the cost to manufacture the drug is between $3.69 to $6 per vial. 

“If I was paying cash for my insulin, if I didn’t have the insurance I have, my insulin would cost me $12,000 a year,” Bentley said while holding up a vial of insulin. 

He added that without the insulin, people can suffer serious health consequences, such as losing their sight, amputation or even death. 

Rep. Patti Minter, D-Bowling Green, whose son has Type I diabetes, said, “No one should lose their sight because they don’t have access to something that costs $6 a bottle to manufacture. ” Minter is a primary sponsor of the bill.

According to the 2020 Kentucky Diabetes Fact Sheet, 13.7% of Kentuckians have been diagnosed with diabetes, and an estimated 158,200 adults have the disease, but are undiagnosed. Not all use injectable insulin. 

HB 95 passed the House 95-0 to a round of applause. A similar bill passed the House during the last legislative session, but died in the Senate as legislative business was truncated by the pandemic.  

HB 219, also sponsored by Bentley, would remove pharmacy recordkeeping requirements for sale of hypodermic syringes or needles and allow their sale of without a prescription, with a limit of 30 of each and proof that the purchaser is 16 or older.

"House Bill 219 removes obsolete recordkeeping requirements for the sale of hypodermic syringes by pharmacies. The goal is to increase the availability of syringes in order to reduce the spread of diseases such as HIV, which turns into AIDS and hepatitis C," said Bentley. 

He added that as it stands, people who buy syringes and needles in pharmacies have to sign a black book that asks what that person plans to use them for, and removing this requirement "destroys that stigma." 

After changes in committee and on the floor, the bill would require pharmacies offering retail sale of syringes and needles to provide educational materials on safe and proper disposal of the products; referral information for syringe exchange programs and treatment of substance-use-disorder; and to offer a naloxone prescription that could be used to reverse an opioid overdose. It passed 97-0. 

HB 276, sponsored by Rep. Kim Moser, R-Taylor Mill, would allow nurse's aides who were trained as temporary Covid-19 personal-care attendants under an emergency executive order from Gov. Andy Beshear to apply their supervised training toward their state certification and registration. Moser said the bill will affect about 300 attendants who have been working in long-term care during the pandemic. The bill passed 96-0. 

Sen. Ralph Alvarado (LRC photo, Jan. 9)

Senate Bill 51, sponsored by Sen. Ralph Alvarado, R-Winchester, would ban the requirement of prior authorization for any prescription drug that is used in the treatment of alcoholism or opioid-use disorder that contains methadone, buprenorphine or Naltrexone, or that is approved by the U.S. Food and Drug Administration for the mitigation of opioid withdrawal symptoms. 

Prior authorization is a process insurers use to get their approval before a patient can get a drug. Alvarado, a physician, said such authorizations are common for these medication-assisted therapies and can take days or weeks. 

"Providers are routinely stymied by PA requirements at the critical moment when patients are ready to begin treatment and address their alcohol or opioid use disorder," he said, adding that the requirement puts the patient at risk of "relapse, overdose or even death." 

The bill also calls for an annual report to be sent to the Department of Insurance that shows the number and type of providers that have prescribed medication for addiction treatment, broken down by those who prescribed it in conjunction with behavioral therapy and those who did not prescribe it in conjunction with behavioral therapy. 

"Frankly, in conclusion, this is going to help save lives here in the state of Kentucky," Alvarado said. The bill passed 34-0.