Independent pharmacists start ads asking Congress for relief from pharmacy benefit managers, ask Supreme Court to hear a case

Photo by Getty Images via The Commonwealth Fund

Kentucky Health News

Independent community pharmacists have begun an advertising campaign to get Congress to rein in pharmacy benefit managers, the middlemen between drug and health-insurance companies. They are also challenging a court ruling that could negate the PBM reforms made by Kentucky and other states.

The ad campaign was launched Thursday, June 13, by the National Community Pharmacists Association. Its CEO, B. Douglas Hoey, said "Eighty percent of all prescriptions in the U.S. are controlled by just three pharmacy benefit managers, and they are all owned by or affiliated with the largest insurance companies in the country. These are Fortune 15 corporations that behave like monopolies, and they are hurting patients with higher prescription costs and killing off small businesses at the average rate of one every day. There is broad bipartisan support in Congress for reform, and we are determined to get it passed before the end of the year."

On Friday, June 14, NCPA joined other pharmacy groups in asking the U.S. Supreme Court to reverse a recent decision from the Tenth Circuit Court of Appeals against a 2019 Oklahoma law than bans PBMs from requiring patients to pick up their prescriptions from PBM-affiliated pharmacies. The groups say the ruling "imperils laws enacted in almost every other state following the 2020 Supreme Court ruling" that approved state regulation of PBMs, reports Gabrielle Wanneh of Inside Health Policy.

In 2023, the Kentucky General Assembly passed Senate Bill 188, aimed at keeping 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 that 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 a 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.

Today is World No Tobacco Day; youth group coordinated by UK pharmacy student aims for tobacco-free future for Kentucky

Members of the #iCANendthetrend Youth Advistory Board and

and UK coordinator Griffin Nemeth pose with Gov. Andy Beshear

outside the state Capitol. (UK College of Pharmacy photo)

By Rosa Mejia-Cruz

University of Kentucky

On this World No Tobacco Day, May 31, the importance of educating and engaging youth in tobacco use prevention cannot be overstated. The theme of this year's observance, "Protecting children from tobacco industry interference," emphasizes the vital role young people play in promoting healthier lifestyles and positive community change.

According to the World Health Organization, an estimated 37 million youths aged 13–15 use tobacco globally, with children surpassing adults in elecgtronic-cigarette usage in all regions. 

Griffin Nemeth, a student at the University of Kentucky College of Pharmacy and coordinator for the #iCANendthetrend Youth Advisory Board, exemplifies the significant impact young people and pharmacists can have in this public-health mission.

Nemeth's involvement in tobacco prevention began his sophomore year of undergraduate studies through his role as a college facilitator with #iCANendthetrend, a youth e-cigarette prevention and empowerment initiative. Project Director Melinda Ickes, a professor in the UK College of Education, worked with students to bring a near-peer prevention approach to decrease initiation of tobacco use by youth, support those who are already dependent on tobacco, and ensure that student voices are at the forefront of prevention and policy advocacy.

Since 2019, the team has reached more than 20,000 Kentucky youth. The advisory board, a group of 10 high school advocates from across Kentucky, fosters a generation of changemakers dedicated to educating peers, community members and policymakers about the negative health outcomes of vaping and tobacco use.

“I am thrilled to see young people engage in something they traditionally haven't been involved in, especially in the policy sphere,” said Nemeth. “Witnessing our Youth Advisory Board advocate for their communities and interacting with local leadership is immensely rewarding."

A key element of Nemeth's work is the comprehensive, yearlong training program he helps coordinate for younger Kentuckians. Each summer, new members of the Youth Advisory Board gather at UK for an in-person training session, followed by bimonthly virtual meetings throughout the year. This training includes online modules, skill-building opportunities and sessions led by near peers who are part of #iCANendthetrend. Each year, the Youth Advisory Board selects a project to work collaboratively on throughout the year to equip them with the knowledge, skills and confidence to effectively support their goals.

The #iCANendthetrend program's efforts have earned significant recognition. The Campaign for Tobacco-Free Kids named the board the 2024 Group Advocates of the Year, highlighting the critical contributions of youth in tobacco prevention and the necessity for ongoing support.

Pharmacists are uniquely positioned to support tobacco cessation efforts. With most people in the U.S. living within five miles of a pharmacy, trained pharmacists can bridge the gap in treatment resources, particularly in rural areas.

"Even if patients are unsure they want to begin treatment, pharmacists can ask, advise and refer, which can make a significant difference for a patient who might otherwise continue to smoke for years until a severe health condition develops,” Nemeth said. “Pharmacists can play a crucial role in early intervention.”

As Nemeth advances in his pharmacy studies, he remains committed to advocacy. He envisions a future where his role as a pharmacist intersects with his passion for public health. "There's a significant health disparity in tobacco prevention and use, especially in Kentucky. Learning about the science and treatment in pharmacy school has further prepared me as an advocate," Nemeth explained.

For those looking to reduce or quit tobacco use, pharmacists offer invaluable support. Many pharmacies provide resources and counseling for smoking cessation, including nicotine replacement therapies and other medications to manage withdrawal symptoms. Pharmacists can also offer personalized advice and support, making it easier for individuals to navigate their cessation journey.

World No Tobacco Day 2024 is a call to action for health care providers, communities and individuals to support tobacco prevention and cessation efforts. By combining the power of youth advocacy, the accessibility of pharmacists and the collaboration of health-care providers, educators, policymakers and community leaders, Kentucky can move toward a tobacco-free future. This comprehensive approach, which includes prevention, education, policy advocacy and accessible treatment resources, is essential for ensuring healthier lives for generations to come.

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.

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.

State and federal lawmakers say they're still trying to rein in health-insurance middlemen, called pharmacy-benefit managers

By Melissa Patrick
Kentucky Health News

A day after Gov. Andy Beshear talked at a White House roundtable about Kentucky's moving to one pharmacy-benefit manager for Medicaid, First District U.S. Rep. James Comer, spoke at another Washington event about his efforts to reform PBMs as chair of the House Committee on Oversight and Accountability.

U.S. Rep.  James Comer

“The focus of what PBMs' role should be, should be to help the consumer have more choice, have lower costs," Comer said at a March 7 event hosted by The Hill. "But what’s happening is the focus now with the PBMs is which drug can we make the most profit off of, regardless of what’s best for the patient. And I don't think that's a good business model." 

PBMs are middlemen between insurance plans and drug manufacturers; they determine what drugs are offered, how much someone pays for the drug, and how much pharmacists are paid.  

Earlier this year, Comer's committee passed with broad bipartisan support the Delinking Revenue from Unfair Gouging (DRUG) Act, which would rein in practices by some PBMs that offer health plans under federal employees' health program. 

Comer said PBM reform remains a priority, and his committee has received more than 40,000 pages of documents for a report that will be released "very soon." He said his panel will have another hearing once the report is release to discuss next steps.

He said those who understand the issue "realize that PBMs have actually added cost to the consumers" at a time when everyone recognizes that the rising cost of prescription drugs is not sustainable. 

Despite congressional concern about the issue, the government-funding bills just signed by President Biden do not include PBM reforms. Asked if they could pass in the "lame duck" session after the November elections, Comer, using his own committee as an example, said, "I think something can always be done before." 

Comer said much of the problem comes from three major PBMs controlling 80% of the market, noting that they are owned by health-insurance companies and have their own mail-in pharmacies. 

“I believe PBMs have had a negative impact on competition, especially among community pharmacists,” he said. “I believe they have an unfair competitive advantage. I believe they’re doing a lot of things that are unethical at best and should be illegal at worst with respect to – I would even go as far as saying extorting fees from independent pharmacies. We’re losing independent pharmacies.”

Kentucky lawmakers have been working on PBM issues for years. Most recently, in 2020, they passed a bill sponsored by Sen. Max Wise of Campbellsville, a Comer ally, that required the state to hire a single PBM for the state's Medicaid program. Before this law, each of the six companies that manage Medicaid for the state had its own PBM.  

At the White House roundtable, Beshear talked about the legislation and how he began investigating PBMs' drug-pricing methods when he was attorney general in 2016-19.

“That single PBM that answered to us, and not to any other company, has allowed Kentucky Medicaid to maximize drug rebates and has saved our Kentucky families about $300 million since we've done it,” he said. “And it allowed us to understand more about how to get the right price.”

Kentucky PBM reform efforts are ongoing

Wise's latest PBM reform measure is Senate Bill 188, which involves PBM reform efforts on the commercial market.  

State Sen. Max Wise

“I’m optimistic this measure will yield similar savings by applying the same standards to the commercial market, effectively cutting costs for Kentuckians with private health insurance plans,” Wise said in a Feb. 8 news release about the bill.  

SB 188 "aims to empower citizens to choose where they purchase their medication, prevent further closures of community pharmacies and ensure fair reimbursement rates for these essential health care providers," said the release.  

SB 188 has been assigned to the Banking and Insurance Committee. It has not yet been heard or voted on in committee, but has received its first reading, an indication that it has a chance for passage. 

Another bill that addresses PBMs passed out of the House Health Services Committee on March 7. House Bill 190, sponsored by Rep. Scott Sharp, R-Ashland, was approved unanimously and was placed in the House for possioble action as early as Monday, March 11. 

State Rep. Scott Sharp

HB 190, as amended by a committee substitute, would allow people to receive their medication directly from the mail, but if it does not get there in time, they would have the option to purchase it from their local pharmacy at the same price it would cost if it was mailed to them.  

Sharp said he was prompted to file this bill because of a personal experience. 

He said he went to his local pharmacist to get a drug for a family member who was having some trouble getting it delivered. He said he was told it would cost $400, instead of the $36 it would cost if it came by mal. 

Upon talking to his PBM, he learned that this was the "penalty" for using his local pharmacy, instead of getting it mailed direct. Since, he said he's learned that this is a common problem and that's why he wants to "fix it." 

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." 

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.

Pharmacy benefit managers' group ranked No. 7 in spending for lobbying the General Assembly, after laying out $53,634 for ads

Commonwealth Fund flow chart, amended by Kentucky Health News to include patients and employers

By Al Cross
Kentucky Health News

The lobbying organization for pharmacy benefit managers, the middlemen between insurance companies and drug manufacturers, spent $86,168 in its successful effort to defeat a bill in the recent legislative session that would have reined them in. They prevailed over pharmacists with the help of insurers, who argued that the bill would raise costs.

The Pharmaceutical Care Management Association ranked seventh in spending by lobbying interests in the session that ended in mid-April, mainly because it spent tens of thousands of dollars in television commercials attacking the bill. The ads started the day the bill overwhelmingly passed the House, where a pharmacist-legislator was the sponsor. PCMA said it spent a total of $53,634 on TV, internet and newspaper ads.

The bill got nowhere in the Senate, where President Robert Stivers said "When it got here, we started getting, from business sector and provider sector, various questions and comments about what the overall cost would be to various plans."

Tom Stephens, executive director of the Kentucky Association of Health Plans, cited a state Department of Insurance statement that a family of four would have paid up to $167 more a year for coverage if the bill had passed.

House Bill 457 would have ensured that patients could pick their pharmacy, instead of being required to use one affiliated with a pharmacy benefit manager; increase transparency between insurers and PBMs; and ban PBMs from retroactively denying a pharmacy claim after adjudication, commonly referred to as "clawing back." It passed the House 88-3.

The Federal Trade Commission voted Tuesday to investigate how pharmacy benefit managers affect the cost of prescription drugs and consumers' access to the drugs.

Several other health-care interests, or lobbying groups with interests in health care, were big spenders on lobbying the session, according to their post-session reports. The Kentucky Chamber of Commerce was again No. 1, spending $183,949; the Kentucky Hospital Association was second with $149,046. Third and fourth were the American Civil Liberties Union of Kentucky, whose issues include abortion rights, $128,258, and Altria Client Services (Philip Morris Cos.), $126,793. Insurer Anthem Inc. ranked 10th by spending $70,597.

Other big health spenders were the Kentucky Medical Association, 16th, at $54,044, and HCA Healthcare, 22nd at $48,832. The state Legislative Ethics Commission’s searchable register of lobbyists, employers and lobbying expenses is online at http://apps.klec.ky.gov/searchregister.asp.

OPINION: Insurers say killing bill hospitals, pharmacists backed against pharmacy benefit managers saved Kentuckians money

By Tom Stephens
Executive Director, Kentucky Association of Health Care Plans

Pocketbook issues were front and center in this most recent session of the Kentucky General Assembly as runaway inflation at the national level continues to outpace wage gains. Lawmakers and the governor worked to ease inflationary burdens for working families by offering relief on hefty vehicle property tax increases caused by a pandemic surge in used car values. The General Assembly also moved to lower the personal income tax to keep more dollars in taxpayer wallets.

Tom Stephens

There were encouraging policy moves in health care as well. One driver of cost increases are government health-benefit mandates, which can add as much as 5 percent to coverage premiums. Kentucky has more healthcare mandates than the national average, but with a few exceptions, legislators largely resisted pressure from powerful lobbying groups to add more in 2022. This was a big win for Kentucky businesses and employees.

One group, the Kentucky Pharmacists Association, worked with an independent pharmacist in the General Assembly to introduce HB 203, a lengthy mandate bill that would have added a minimum $10.64 dispensing fee (5 times the current rate) to Kentuckians’ prescription drugs. The legislation also would have ended quality-driven, pay-for-performance contracts, significantly limiting the ability of companies and health plans to negotiate better pharmacy prices for their employees and members. This would have created a guaranteed payday for high-cost pharmacists. To further tip the scales in their favor, a pharmacist-controlled board would have been established to set future policies on prescription drugs.

As part of their legislative strategy, the pharmacists worked to broaden support for HB 203 and ratchet up pressure by allowing lobbyists for certain hospital systems to insert monopolistic provisions on specialty drugs (medications administered by a provider through injection or infusion typically, in a hospital outpatient setting or a provider’s office). This measure effectively banned a successful innovation known as “white bagging” or “alternate sourcing,” whereby health plans and businesses fight hospital price gouging by using specialty pharmacies to safely distribute these drugs.

Sensing a growing concern over the costs and complexity of the bill, proponents quickly pulled HB 203 before an official Kentucky Department of Insurance cost assessment could be posted. A Pharmaceutical Care Management Association analysis estimated that HB 203 would have increased prescription drug costs by a staggering $5 billion over the next decade. (Editor's note: PCMA lobbies for pharmacy benefit managers, firms that are middlemen between insurance and drug companies, determining what drugs are offered, at what price, and how much pharmacists are paid.)

Immediately upon withdrawing HB 203, a slightly revised bill, HB 457, was introduced. It also drew heavy opposition from multiple Kentucky employers, including the Kentucky Association of Manufacturers, General Electric, Mercer and dozens of other Kentucky employers. The Kentucky Association of Health Underwriters rang the alarm: “This bill does nothing to address the cost of prescription drugs, it’s going to do the opposite.” The Kentucky Association of Health Plans pointed to the negative impacts by reminding legislators that the Department of Insurance statement showed a family of four would have paid up to $167 more a year for health coverage.

Fortunately for Kentucky businesses and individuals, HB 457 was not enacted into law. Senate President Robert Stivers illuminated HB 457’s potential effects in an end-of-session press conference when he said, “we started getting, from the business sector and the provider sector, comments and questions about what the overall cost would be to various plans because it would have cost impact on various health insurance plans, including potential fiscal impact to the state employees’ health plan.”

Kentucky businesses would be wise to stay vigilant and continue to raise their voices against expensive health care mandates and disruptions in the healthcare marketplace through legislation that does not have broad support from all stakeholders.

KAHP Executive Director Tom Stephens can be reached at tom@kahp.org.

Albany pharmacist who led U.S. in dispensing opioids pleads guilty to federal charges, pays $200K and faces 15-month term

Shearer Drug in July 2019 (Washington Post photo / Michael Williamson)

Albany pharmacist Kent Shearer, whose drug store dispensed more opioids than any other in the United States from 2006 through 2012, has pleaded guilty to three counts of illegal distribution of controlled substances, the U.S. Justice Department announced Jan. 28.

The U.S. attorney for the Western District of Kentucky filed the charges in a criminal information on Jan. 10, but Shearer had been under investigation for a long time, after Clinton County Coroner Steve Talbott called police because of the number of drug overdoses in the county. Michael Cummings, a physician who had his office in the same building as Shearer is serving 30 months in prison on 13 counts of illegal prescribing.

Two charges said that between August 2011 and June 2014, and in 2015, the store dispensed hydrocodone "for patient J.Y., even though Shearer knew that the prescriptions were not written for a legitimate medical purpose. Shearer knew J.Y. was doctor shopping to obtain prescriptions for the same medications from multiple doctors, and because the . . . cough medicine . . . Dr. Michael Cummings prescribed to J.Y. had been prescribed for far longer than recommended in prescription guidelines." One of the charges said "Shearer filled prescriptions early on multiple occasions."

Clinton County (Wikipedia map)

The other charge said that between August 2011 and April 2015, the store dispensed alprazolam, commonly known as Xanax, for the same patient though he "knew that the prescriptions were not written for a legitimate medical purpose. Shearer knew J.Y. was doctor shopping to obtain prescriptions for the same medications from multiple doctors, and because Shearer filled prescriptions early on multiple occasions."

Prosecutors said they would seek a sentence of 15 months in prison followed by three years of supervised release, and Shearer "has agreed to forfeit a $200,000 monetary judgment to the United States" on or before the sentencing date of May 14, 2020. He has sold his business to another local pharmacy, the Clinton County News reports.

Pharmacies could help get more teens vaccinated for a virus that causes sex-related cancers, in which Kentucky leads the nation

Alabama Department of Public Health

There's a vaccine for a virus that causes sex-related cancer, but rural teens are less likely to get it or know about it. Rural pharmacies could help improve vaccination rates, writes Casey Daniel, a Ph.D. pharmacist who teaches in the family medicine department at the University of South Alabama.

"Human papillomavirus (HPV) is the most common sexually transmitted infection, with 80 million Americans currently infected and 14 million new cases of infection each year," Daniel notes, but only about two-thirds of 13-to-17-year-olds start the HPV vaccine series, and fewer than half have up-to-date vaccinations. Kentucky's rates are much lower; less than half get any shots and only a third get the full series. Probably due to that, the state has the highest rate of HPV-related cancers in the nation.

Rural HPV vaccination rates are 11 percent lower than urban rates, partly because rural areas have fewer health-care providers, Daniel writes in the Journal of Rural Health. He says that gap could be filled by pharmacies, which are more widespread than doctors' offices and open longer hours. "In the 2018 President's Cancer Panel report on HPV vaccination for cancer prevention, pharmacies were specifically recommended as a way to increase vaccine accessibility," he writes. "Most pharmacies are also ideally suited for immunizations because of their inherent infrastructure and storage capacity for various medications. Many pharmacies offer vaccines such as flu, pneumonia, and shingles, and therefore, they have established immunization protocols that can be easily adapted to HPV."

Convenience is important for HPV immunization "because this vaccination is a multi-dose series requiring subsequent visits," Daniel writes. "While large chain pharmacies have a broad, mass market appeal, there is a considerable case to be made for collaborating with 'community pharmacies' as alternative settings for HPV vaccination, particularly in rural and small-town settings. In these areas, independent community pharmacies are often an established part of the community. Community pharmacists frequently have personal relationships with their patients, knowing them both within and outside the bounds of the pharmacy, and have a unique, established trust. They are trusted providers within the community, acting as the first line of health care and consultation for many patients."

That's also important for HPV immunization because research has shown that rural parents are less likely to be aware of HPV and the vaccine. Community pharmacists "frequently have personal relationships with many local individuals," Daniel writes. "Therefore, they can function in both education and reinforcement regarding the importance of HPV vaccination. . . . In the exploration of alternative settings to increase HPV vaccination, community pharmacies have been significantly overlooked. Particularly in rural settings, these pharmacies have vast potential to reach under-served, disparate populations and serve crucial roles in addressing community health care needs and filling resource gaps."

Report says Kentucky Medicaid could save nearly $240 million by cutting middlemen between drug makers and pharmacists

Kentucky's Medicaid program could save nearly $240 million a year by eliminating pharmacy benefit managers and returning to its old "fee for service" system of reimbursing pharmacists for each prescription, a state report says.

Pharmacy benefit managers are the middlemen between insurance and drug companies. The PBMs have much power; they determine what drugs are offered, how much someone pays for the drug, and the payments to pharmacists.

The report was done by the independent accounting firm Myers and Stauffer, which is a national expert on prescription drug pricing, Deborah Yetter reports for the Louisville Courier Journal.

Kentucky lawmakers have been working on PBM issues for years. Most recently, they called for increased scrutiny of PBMs' pricing practices. The bill's sponsor, Republican Sen. Max Wise of Campbellsville, told Yetter that this report sheds some light into what's in the "black box" as lawmakers look into "unfair practices that are harmful."

Wise was referring to a separate report issued earlier this year, "Medicaid Pharmacy Pricing: Opening the Black Box," which found two PBMs kept $123.5 million last year from the state's Medicaid program by paying pharmacies a lower rate to fill prescriptions, while charging the state more for the same drug, a process that is called "spread pricing."

Wise told the Courier Journal that he didn't know what would result from the report, but said he plans to "take it up with legislative leadership to discuss possible changes in state law," Yetter writes.

Independent pharmacies in Kentucky and around the nation have said for years that the payment practices of PBMs are so bad that they threaten their survival.

Greg Lopes, a spokesman for the Pharmaceutical Care Management Association, a trade group for the PBMs, told Yetter, “Pharmacy benefit managers are hired to reduce prescription drug costs and improve the quality of benefits for consumers, employers, and public programs, including Medicaid."

The report makes no recommendations on what Kentucky should do, and a spokeswoman for the Cabinet for Health and Family Services, which oversees Medicaid, told Yetter that its Department of Medicaid Services, which sought the study, had no recommendation either.

But Kentucky pharmacists were quick to call for reform, Yetter reports.

"The savings estimated in this report demonstrate that overpaying PBMs to administer pharmacy benefits is an untenable situation that must be remedied," Don Kupper, president of the Kentucky Pharmacists Association, said in a statement.

And Rosemary Smith, co-founder of the Kentucky Independent Pharmacists Association, told Yetter that the report provides a much-needed framework to reform the system. Smith and her husband, Luther, own six Eastern Kentucky pharmacies.

"We need to act immediately," Yetter heard from Shannon Stiglitz, vice president of government affairs for the Kentucky Retail Federation. "For many years, the pharmacy benefit managers have told us they save dollars," she said. "Now we know and this report is evidence that those savings go to their bottom line at the expense of patients, taxpayers and providers."

Kentucky Medicaid, which gets about 80% of its money from the federal government, spends about $1.5 billion a year on drugs. The report estimates that eliminating PBMs, it could save about $237.5 million a year — keeping about $45 million for itself, with the rest of the savings being the federal share of the money, Yetter reports.

"That conflicts with the findings of state Medicaid officials in 2018 that a carve-out of prescription drugs could cost the Medicaid program an additional $200 million a year, $36 million of that in state funds," Yetter writes.

Both Smith and Kupper recommend returning to the fee-for-service system, which is already used for patients outside Medicaid managed care, such as nursing home residents and those in special Medicaid programs for people with disabilities, Yetter reports.

"We already have the system in place to take this back," Smith said. "We have the resources. We have the staff and we can save the state all of this money."

The state Medicaid program contracts with five managed care companies that in turn subcontract with PBMs. The PBMs then contract with pharmacies. CVS Caremark, an affiliate of the drugstore chain, has most of the PBM business in Kentucky, handling prescription drug claims for four of the five managed-care companies.

Albany doctor's weight-loss clinic sees big results with old-fashioned methods: eat better food, less of it, and exercise

Dr. Carol Peddicord holds a model representing

five pounds of body fat. (Clinton County News photo)

A doctor and a pharmacist in rural Albany are seeing big results in the fight against obesity after opening a weight-loss clinic. Since The Doctor's Health and Weight Loss Clinic opened in January, its 433 patients have lost a collective 4,079 pounds, and most have maintained their weight loss, Brett Gibson of the Clinton County News reports.

Dr. Carol Peddicord and pharmacist Arica Collins of Dyer Drug Co. came up with the idea for the clinic after seeing how many patients came in looking for a quick fix to lose weight. But the best way to do that is to live a healthier lifestyle, not through a pill or a crash diet, the News reports.

The emphasis is on healthier, Peddicord told the News: "We don’t want people to be skinner, we want them to be healthy and live longer." Obesity is a significantly bigger problem in rural areas than in suburban and urban areas, according to the Centers for Disease Control and Prevention. Among adults, 34.2% of rural residents are obese, compared with 28.7% in metropolitan counties. Kentucky has the fifth highest adult obesity rate in the nation, at 36.6%, and the third highest rate for youth 10 to 17, at 20.8%,

Though the duo first conceived of the clinic because they were worried about children's health, most of their patients are women between 35 and 58. There are a few high schoolers, though, and they're starting to see more men coming in. That's good, Peddicord told the News, because men typically have heart disease earlier in life.

Albany, in Clinton County (Wikipedia)

The clinic, which takes insurance, offers individually tailored wellness plans for patients, depending on whether they have high blood pressure, diabetes, and/or heart disease. They offer diet plans and will soon have plans for meal replacements such as shakes, the News reports.

Though Peddicord was glad to note that the clinic's patients had lost 680 pounds last month, she told the News that pounds aren't the only thing that matter. Patients have seen other "non-scale victories" such as being able to stop taking insulin for diabetes. "People are losing weight, feeling better and are able to exercise," she said.