State's high maternal-death rate gets study; pregnancy-related deaths mostly from violence, substance use, anxiety, depression

UK researchers studying the state's high maternal-mortality rate include (front row, left to right) Anna Chamberlain, Ann Coker, Linda Berry, Heather Bush; (back, left to right) John O'Brien, Cynthia Cockerham, Dana Quesinberry and Josh Bush. (Photo by Jeremy Blackburn, UK Research Communications)

Thursday, April 11 is the International Day of Maternal Health and Rights.

By Lindsay Travis
University of Kentucky

A team of health-care providers and researchers at the University of Kentucky is working with community and government leaders across the state to address a pressing issue facing the state: its high rate of death and illness among women who give birth.

“Kentucky has one of the highest maternal mortality rates in the country. Lowering the proportion of women dying during or after childbirth in our state is not just a goal, but a necessity to safeguard the health and futures of both mothers and their children,” said Dr. John O’Brien, director of the Division of Maternal Fetal Medicine at UK HealthCare. O'Brien is also a professor in the Department of Obstetrics and Gynecology in the UK College of Medicine, and the appointed chair of the Kentucky Maternal Morbidity and Mortality Task Force in the state’s Cabinet for Health and Family Services.

The task force is funded by a $5.2 million, five-year grant from the Health Resources and Services Administration of the U.S. Department of Health and Human Services.

The state has a Maternal Mortality Review Committee that determines the causes of maternal deaths and identify opportunities for preventing future deaths, through policy or practice. The panel has documented that substance use, injury and behavioral-health conditions are all common contributing factors to maternal death or maternal illness, also called maternal morbidity.

“In Kentucky, the study of severe maternal morbidities reveals a stark reality that these outcomes are deeply intertwined with health-care disparities,” O’Brien said. “Rural communities and people of color bear a disproportionate burden, highlighting the urgent need to address systemic inequalities in maternal healthcare access and quality.”

O'Brien's task force will work with hospitals, other health-care providers, community partners and state agencies to implement and promote best practices to make birth safer, improve maternal health outcomes and, ultimately, save lives.

The task force will work with state agencies to develop a scorecard to track severe maternal-health issues, using hospital records. The team will also create a data surveillance system to monitor maternal deaths and injuries, with a goal of making this information publicly available.

“Our team also wants to be able to provide critically important hands-on learning opportunities for smaller hospitals to be prepared to handle pregnancy-related complications,” said O’Brien. “We also want to extend and assist coordination of telehealth services to birthing facilities throughout the state as we have shown reduction of severe morbidity in rural communities is possible through telehealth availability.”

The federal grant will also fund bystander-informed violence intervention and prevention training specifically for obstetric health-care providers to address maternal health related to violence.

“In Kentucky, the majority of pregnancy-associated maternal deaths stem from partner or family violence, substance use and anxiety or depression,” said Dana Quesinberry, associate director of the Kentucky Injury and Prevention Research Center and an assistant professor of health management and policy in the UK College of Public Health. “Our goal is to leverage our collective expertise to share violence intervention and prevention training models statewide to make a targeted effort to reduce these types of death.”

“The majority of violence-related maternal deaths ARE preventable. We are firm in our belief that this proactive approach will offer hope to mothers in our state and make a measurable difference in health outcomes,” said Ann Coker, one of the team leaders on the project. She is the Verizon Wireless Endowed Chair in the Center for Research on Violence Against Women and a professor of epidemiology in the Department of Obstetrics and Gynecology.

O'Brien said, “This task force is a comprehensive project involving multiple stakeholders and a crucial step for Kentucky moving forward. By uniting expertise, resources and advocacy, our goal is to ensure every mother receives care and support.”

In addition to the grant, HRSA provided $170,233 to be used for Medicaid redetermination and postpartum-care coverage navigation for pregnant and postpartum individuals and their families. “We have utilized these funds to establish a Perinatal Community Health Worker Program . . . to provide culturally and linguistically matched services to pregnant and postpartum persons in the state,” said Cynthia Cockerham, community program and research director for UK HealthCare’s Division of Maternal Fetal Medicine.

The study team also includes Linda Berry, a registered nurse and perinatal substance use coordinator at UK HealthCare; Public Health Dean Heather Bush, an endowed professor in the Center for Research on Violence Against Women; and Dr. Barbara Parilla, medical director of the UK HealthCare Perinatal Assistance and Treatment Home (PATHways) program and a professor in the Department of Obstetrics and Gynecology.

To inquire about the task force, email Kentucky_MMM@uky.edu. For more information about the Perinatal Community Health Worker Program, email PerinatalCHW@uky.edu.

A webinar to discuss how a new Transforming Maternal Health Model provides opportunities to improve rural maternal-health access will be held at 12:30 p.m. ET April 18. This is the newest model from the Centers for Medicare and Medicaid Services.  At 2 p.m. April 23, the Rural Helath Information Hub is hosting a webinar obstetric readiness in rural facilities without birth units.

Despite waiting list, a shortage of nurses and plenty of money, governor and legislature don't fund new building for KSU nursing

Kentucky State University’s nursing program has outgrown the Betty White Health Center, opened in 1971. Nursing classes are spread in buildings across campus. (Kentucky Lantern photo by Jamie Lucke)

By Sarah Ladd
Kentucky Lantern

Kentucky State University requested $50 million this year to build a nursing school for its growing class of future health care providers. The governor and legislature rejected the request, even though the KSU program has a waiting list and Kentucky suffers from a shortage of nurses but enjoys a record surplus.

“The real tragedy is that we had the money to do it,” Rep. George Brown Jr., a Lexington Democrat, told the Lantern last week. He called the omission “a travesty.” Brown and other lawmakers said the decision is part of a long pattern of neglect and underinvestment in historically Black colleges and universities (HBCUs) — a disparity the Biden administration also has highlighted.

It’s “always been the history,” said House Democratic Floor Leader Derrick Graham, a KSU alum who urged Republican legislative leaders to fund the nursing building.

During House debate, Black lawmakers pointed out that Kentucky’s only public HBCU was being denied $50 million for a project they deem critical to its future, while $125 million was quickly found for Northern Kentucky University and the University of Kentucky to open a biomedical center in downtown Covington, where plans also call for NKU to move its law school.

The Senate added the Covington project to House Bill 1, which moves $2.7 billion from the Budget Reserve Trust Fund into one-time spending over the next two years. HB 1 includes other higher education projects: $60 million for a veterinary tech facility at Murray State University, $25 million for a UofL Health cancer center in Bullitt County and $22 million for a livestock innovation center at a UK research farm.

“Kentucky State always seems to suffer and always has to wait,” Brown said March 29 on the House floor. “‘You have to wait your time; it’s not your time.’ … So the question is, when will it be Kentucky State’s time?”

When budget negotiators met in a free conference committee on March 26, Graham asked why KSU’s “top priority” was not included in budget legislation. Graham represents Frankfort where KSU sits on a hill overlooking the capital city. Sen. Chris McDaniel, chairman of the Senate budget committee, said KSU had also revised its budget request by asking for money to deal with failing infrastructure and other maintenance needs.

House Bill 6, the budget bill, sets aside $60 million in bonding for “asset preservation,” described by McDaniel as “cleaning up campus.” House Bill 1 includes $5 million to design a Health Science Center for the nursing program but nothing to build it. McDaniel vowed “full intent” to pay for construction of KSU’s nursing building in the 2026 budget bill. McDaniel’s district includes Covington; he was instrumental in obtaining the $125 million for the downtown project involving NKU.

“We have a great deal of confidence in the new president of Kentucky State,” McDaniel said in the March 26 meeting. He was speaking of Koffi Akakpo, who became KSU’s 19th president last year on July 1. Before that, he was president of Bluegrass Community and Technical College.

HB 6 provides all the public higher-ed institutions with asset preservation funding pools for renovation and maintenance of buildings and other infrastructure.

During the free conference committee meeting, Democratic Senate leaders Gerald Neal of Louisville and Reggie Thomas of Lexington, both of whom are Black, said that expanding KSU’s nursing program is critical to the school’s rebound from recent troubles. The construction delay will cost KSU new students and needed tuition revenue and disrupt Akakpo’s plan for the future, said Neal.

Neal and Thomas urged the budget negotiations to reconsider. Thomas suggested spending less on restoration and maintenance at KSU in this budget to free up $50 million over the next two years to design and build the nursing building.

Senate Republican Floor Leader Damon Thayer of Georgetown responded ​​that KSU was “probably lucky that they get the taxpayer money that they have been getting and continue getting. With the recent numbers and results that have come from K-State, I think we should be dubious moving forward.” He said the “numbers have been pretty embarrassing.”

KSU has faced a series of controversies, including misused funds under a former administration and a 2023 warning from its accreditation body. In 2022, the legislature put KSU under a management improvement plan and provided $23 million to help it recover from a budget deficit.

In an interview with the Lantern last week, Akakpo said he is “grateful” for the $60 million in bonding but that it will “go quickly” as he tackles a list of maintenance needs.

The HVAC system, he said, is “not quite up to par” and the dorms are “in really bad shape.” Sidewalks and entryways need fixing, he said, and “leaky roofs” have caused damage that needs attention. The $60 million does “not quite” cover these needs, he said. “But we will try the best we can.”

A new building for nursing students and money to address maintenance needs were “both equally crucial for us to move forward,” Akakpo told the Lantern.

KSU's 342 nursing students make up 24% of the university's enrollment, and the program is “only going to grow,” said Akakpo. Nursing students study in three separate buildings because no designated building is large enough.

The Betty White Health Center, which is 53 years old, has administrative offices and a learning lab. Students take classes in Bradford Hall, Carver Hall and Hathaway Hall. “The building is needed because the building that is assigned to the nursing program is too small,” Akakpo said. It’s also already full.

Kentucky is thousands of nurses short of what it needs. The state is short 5,391 registered nurses and licensed practical nurses, according to the Kentucky Hospital Association. And, the students going into nursing school aren’t enough to replace those retiring and leaving the workforce.

Brown said KSU’s backlog of maintenance needs stems from historic underinvestment. The historically Black university, he said, is “the redheaded stepchild, if you will” of Kentucky higher education.

The Biden administration last year documented roughly $12 billion in underfunding for HBCUs nationwide when compared with state funding of similar predominantly white institutions.

The study compared land-grant institutions created by Congress in the 19th century, first for white students and later for Black students. KSU and UK are Kentucky’s land-grant universities. In Kentucky the disparity in per student state funding from 1987 to 2020 was $172 million.

U.S. Education Secretary Education Miguel Cardona and Agriculture Secretary Tom Vilsack sent letters to governors, including Kentucky’s, asking for states to right the “historical underinvestment.”

A letter from Cardona to Gov. Andy Beshear cited “unbalanced funding” and “longstanding and ongoing underinvestment” as reasons KSU “has not been able to advance in ways that are on par with University of Kentucky.” It added that “unequitable funding” of KSU put it $172.1 million short of what it would have received in the last 30 years.

The budget Beshear introduced in December did not include money for the KSU nursing building. It did ask lawmakers to allocate about $1.2 million to KSU for nursing and social-work scholarships in 2024-26.

It's a good time to get more active outside, especially as a family

Photo by Fat Camera via Getty Images and Country Living

April is Move More Month, a natural as temperatures warm and outdoor activity is more pleasant. The American Heart Association recommends that children stay active throughout the day and that older youth get an hour of more vigorous physical activity daily.

Exercising as a family is a great way to show your children the importance of physical activity at an early age, the AHA says. Country Living magazine has a list of 40 simple but memorable famili activities for the spring. Here are four ways to get your family moving more this month.

• Limit screen time. Setting boundaries to limit your kids’ screen time is a good place to start if you want your family to be more active. With less time to watch TV or play video games, kids will have to find other ways to entertain themselves. Try finding photo hunt apps and games for your kids that encourage spending screen time outside. Be ready to step in with some non-electronic ways to have fun and get them moving, too.
• Exercise and play together. Set aside time to play and stay active as a family. Choosing activities to complete together can show your kids how fun exercise can be. Hiking a local trail or cycling around your neighborhood can be great ways to spend time outdoors while staying active. Consider going bowling or trying mini golf for a fun change of pace.
• Buy toys that require activity. Getting kids to move more can be as simple as encouraging them to play with toys like kites, skateboards, jump ropes and other things that require movement. Consider gifting them these toys for birthdays and holidays. Keeping these toys near the front or back door in your house can also prompt your children to grab them before heading outside.
• Think outside the box. Gardening and chores might not seem like exercise, but both are great ways to make sure your kids stay active. Planting and caring for a garden will give your kids a reason to spend time outside every day. Chores like raking leaves, shoveling snow and tidying up indoors can keep kids busy and on the move, and it gives you an opportunity to reward them once they’re done.

No matter how you choose to move more this month, make sure you get the whole family involved. The Heart Association has more tips and resources at heart.org/en/healthy-living/fitness/getting-active/how-to-get-your-family-active, and the Centers for Disease Control and Prevention has information about the importance of physical activity for children at cdc.gov/physicalactivity/basics/adding-pa/activities-children.html.

Raising Ky.'s health status has 'a ways to go,' hospital chief says; Chandler says people need to demand change in health policies

Ben Chandler, president and CEO of the Foundation for a Healthy Kentucky, and Christopher Roty, president of Baptist Health Lexington, spoke at the April 4 Lexington Forum. (Photo by Melissa Patrick)

By Melissa Patrick
Kentucky Health News

A discussion on health care at the April 4 Lexington Forum led to information about the many challenges Kentucky faces when it comes to improving the health of its people, and a few solutions.

At several points, Ben Chandler, president and CEO of the Foundation for a Healthy Kentucky, said little will be done to improve health care and health-care costs as long as people don't demand change from their lawmakers in Frankfort and Washington.

"Apparently, it's OK with you guys," Chandler told the Lexington business-and-civic group. "That's all I can say, is that apparently it's OK with you guys because you are not demanding that it change. We can change it through public policy if the citizens of this country wants to do it - and apparently, we don't."

Chandler, 64 and a Democrat, was state auditor and attorney general before losing the 2003 governor's race and representing the 6th District in Congress from 2004 through 2012.

'Kentucky uglies'

Asked about what then-University of Kentucky President Lee Todd called "the Kentucky uglies," referencing the state's most troubling and chronic health issues, Chandler said we don't pay enough attention to them.

"Kentucky's numbers are abysmal," he said. "We have some of the worst health numbers in the United States in almost any health indicator that you can think of, starting with cancer. We lead the nation in cancer . . . and in cancer mortality."

Kentucky ranked No. 41 in the America's Health Rankings 2023 report. Kentucky has found itself among the bottom 10 states in health status since the rankings began in 1990, except in 2008, when it ranked 39th.

Chandler said many Kentuckians work on this problem from a health-care standpoint every day, but "a long, long way to go" remains toward improvement. 

"I think there are some solutions," he said. "But we as a society, at least right now, are not prepared to deal with" them. 

Christopher Roty, president of Baptist Health Lexington, agreed that health-care providers are working on these Kentucky uglies, like obesity, diabetes and lung cancer. 

One way, he said, is by employing new technology, pointing to new protocols for lung-cancer screening that include low-dose CT scans and remote monitoring tools that reduce hospital readmissions. But when it comes to prevention, which involves things like education and poverty, he said, "We've got a ways to go." 

Opioid epidemic

Asked about the opioid epidemic in Kentucky, Roty noted that the hospital has instituted new pain-medication protocols that send people home with just enough medicine for a few days, with instructions to call their doctor if they need more. Also, an addiction nurse at the hospital is available to patients. 

"Lots and lots of progress, but then, we've got a ways to go with that," he said. 

Chandler said the prescription-monitoring system that was created out of a task force he created while serving as state attorney general worked to stop the "proliferation of the pills on the street," heroin quickly followed and "it has been a significant problem ever since." 

Further, he said that despite all of the "really good work" being done to deal with opioid addiction, we haven't figured out how to effectively treat it. 

"We have yet as a society, not gotten the tools to deal with this dreadful addiction," he said. "It's just dreadful. My own brother died of a fentanyl overdose a couple of years ago. . . . There are very few people who have not been affected by this." Chandler was speaking of his brother, Matthew Chandler. 

He added, "We're pouring a whole lot of money into well-intentioned efforts to try to fix people who are already addicted. And we're not doing enough on the preventive side to stop the addiction in the first place. And that's where the money. We need to see what we can do to go upstream to try to deal with some of these things."

That would include, he said, addressing what are often called the social determinants of health, or the social drivers of health status. These include things like education, housing, transportation, food insecurity, education, access to health care, employment and poverty.

'As important as health care is, and it's very, very important, it's only a piece of the problem," he said. "If we want people in our society to be well and to live healthy lives, we've got to work on these social determinants," the biggest of which is poverty. 

"People who don't have resources are less healthy and they live less long," he said, adding later, "It's a problem of equity in our society and quite frankly, I think we ought to be deeply concerned about it." 

The state's latest annual Overdose Fatality Report shows that  2,135 Kentuckians died from overdoses in 2022, with opioids involved in 90% of those deaths, led by fentanyl, which was involved in 72.5% of the deaths. 

Health worker shortage

Roty said a shortage of health-care workers continues to be a problem, saying about 5% of his nurses are "agency" workers for outside firms. Another challenge is that they see a lot of first-year turnover among the nurses, who he said leave for various reasons, including a dislike of shift work. 

Asked how they are addressing this issue, Roty said they are doing what many hospitals are doing, offering all kinds of bonuses and loan forgiveness programs. 

He said some of the schools that produce health-care workers aren't graduating enough students to take care of the shortages: "We've got a new class of nurses coming in this spring, but it's not going to . . . get rid of all the agency workers," who are generally paid more.

Roty noted that Baptist Health is opening a second Lexington hospital, on Interstate 75, in phases. He said the outpatient facility, with a freestanding emergency department, cancer center, surgery center and medical office building will open first, followed by a hospital bed tower.

The hospital's site was selected party to serve rural areas south and east of Lexington. Chandler noted, "The people in rural areas don't have the same services. . . . It's just an urban/rural problem." 

This led to him talking about the "institutional problems" in health care, including the fact that the U.S. spends about twice as much per capita on health care as any other industrialized country in the world, while ranking near the bottom for health outcomes.

"Now, something is wrong institutionally with a system that spends twice as much per capita on a problem and ends up with the 60th best result," he said, adding that any other business with such results would surmise that "something has got to give."  

"People in this country are dying because we can't fix this issue," he said. "They are dying and their quality of life is much poorer than it ought to be. And again, I go back to the social determinants of health. One of the reasons that other societies are doing better than we are . . . is that they do a better job on the social determinants."  

Health-care costs

Roty said they do their best to work with people challenged by the costs of health care, whether that is getting them signed up for Medicaid or a financial assistance program. "It's a broken system when it comes right down to it," he said. 

Chandler added, "There are a lot of citizens who are going bankrupt because they can't pay for their health care." 

Further, he said, the health-care system is hard to navigate, while agreeing with Roty that the system is "incredibly complex" for patients and providers. 

"And for a country as strong and capable as we are, it's just amazing to me that we can't come together and find the answers to these problems," he said. " We actually have an idea about what the answers are, we're just unwilling to implement them. And it's because, as you can imagine, there are interests that are not interested in seeing that implemented. " 

Legislative priorities

Chandler opened this segment of the conversation by saying, "The legislature is not easy to work with, we have found, particularly on these kinds of issues." 

This year, he said the foundation's priority was creation of an "all-payers claims database," which would track all health-care insurance claims (including Medicaid and Medicare) in Kentucky to improve the transparaency of health-care costs in the state. He said 22 states already have this in place. 

"We were unsuccessful in that effort, " he said. "And that's not surprising because it's a complicated thing and it's not really sexy." He added, "At some point, we're going to need to get to the bottom of where all the money is going." 

Other priorities, he said, revolved around the social determinants of health and adverse childhood experiences, which he called "childhood trauma." He added, "We're trying to address those things, but we can't seem to get the legislature to invest in the solutions."

The foundation funds Kentucky Health News but does not control its content.

Drugs for weight loss

Asked about the use of the new weight-loss drugs, like Ozempic and Wegovy, in which Kentucky leads the nation, Roty said Baptist Health would no longer cover them for weight loss because they are too expensive, effective May 1. He said they would only cover it for the treatment of diabetes. Roty said the company, Kentucky's largest hospital chain, has spent $24 million on this drug this year in its employee health plan. 

"We are not going to reimburse for that anymore . . . for weight loss purposes, obesity," Roty said. He acknowledged that "A lot of people are seeing results," but "The expense to us, so to speak, is incredible."

"Baptist Health’s employee health plan has seen significant growth in usage of both these medications since they were introduced, with Wegovy alone seeing a 600% increase in users over the past 13 months," according to a statement provided by Baptist Health. 

Chandler suggested that tackling obesity would ultimately result in overall health-care savings, since so many health conditions are caused by or worsened by obesity. 

"If they are working and they are healthy and they are not hurting people, then ultimately in the long run, while the short-term expense may be very high, in the long term the expenses ought to go down for the society in general in savings on health care." 

The 20th annual State of Obesity report from Trust for America’s Health says 37.7% of Kentucky adults are obese and nearly 72% of the state’s adults are either obese or overweight, tied for sixth place with Delaware. Among the state’s high-school students, 19.6% are obese and 16.2% are overweight.

Legislature, Beshear pass law to protect independent pharmacies in Kentucky from commercial pharmacy benefit managers

By Melissa Patrick
Kentucky Health News

A bill to address an unfair playing field between commercial pharmacy-benefit managers and independent pharmacists has been signed into law and will take effect Jan. 1, 2025. 

Rosemary Smith, co-founder of the Kentucky Independent Pharmacist
Alliance in her store (Lexington Herald-Leader file photo by Silas Walker)

As the final vote for Senate Bill 188 was made late on March 28, Rosemary Smith, co-founder of the Kentucky Independent Pharmacist Alliance, said she received at least 100 texts while watching it unfold on Kentucky Educational Television, many from pharmacists saying they were crying tears of joy and relief. 

"They were in tears for their businesses, for their patients and for, you know, their profession. . . . We were fighting for pharmacy," she said. "It was a huge victory. . . Our legislators listened to the truth and they voted. And it was just amazing." 

Pharmacy benefit managers deal between insurance companies and drug manufacturers; they determine what drugs are offered, how much someone pays for the drug, and how much the pharmacists are paid.

Smith, who owns six independent pharmacies in Eastern Kentucky with her husband, Luther, said getting SB 188 passed was the "fight of the century."

"It was so much harder to get through than Senate Bill 50" in 2020, she said. "It was in the Senate for 48 days. . . . I mean, they fought us with everything," she said of the pharmacy benefit managers' lobby. 

State Sen. Max Wise

Both bills were sponsored by Sen. Max Wise, a Republican from Campbellsville. SB 50 required the state to hire a single PBM for the state's Medicaid program, resulting in savings of $282 million.

SB 188 addresses commercial PBM reform. It 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 Kentucky 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. 

"That's huge," Smith said, "because right now we're getting sometimes a 15 cents dispensing fee and it (can) cost more than $10.64 to fill a prescription. They are paying us below our costs, so you can't stay in business."

The bill also says PBMs can no longer force patients to get their drugs through mail order, nor can they steer patients to the pharmacies that they own. "This was really big," Smith said.

The bill's opponents told Senate and House committees that the legislation will cause insurance premiums to increase and its mandates in the bill won't allow businesses to capitalize on savings that PBMs provide. 

Smith called Medicaid PBM reform a "game changer" for many independent pharmacists, but said it is not enough on its own to save local pharmacies because Medicaid only makes up about a third of most pharmacy's business, with commercial insurance taking up another third and Medicare Part D the final third. 

She said in the last two years, 69 independent pharmacies have closed in Kentucky. 

"They either close or they sell to CVS or Walgreens because they don't have a choice," she said. "They've taken money out of their 401-Ks. . . . They weren't getting reimbursed the cost to stay in business." 

As for the ones that sold, she said, "They sold for pennies on the dollar. They didn't have a choice. They were forced out by their competition." 

The bill passed the Senate March 26 with a committee substitute and a floor amendment on a vote of 35-1. Majority Floor Leader Damon Thayer, R- Georgetown, cast the only "no" vote. It passed out of the House 97-0 March 28 and Gov. Andy Beshear signed it into law on April 5. 

Wise said in a Senate floor speech that SB 188 is an "attempt to protect patients and community pharmacies against predatory PBM practices in the commercial market."   

SB 188 also prohibits a PBM from reimbursing a pharmacy that it owns at a higher rate than a community pharmacy or to prohibit a community pharmacy from filling a 90-day prescription for a maintenance drug. Nor can a PBM penalize a community pharmacy from sharing information with a patient on the cheapest option to pay for their medications. 

Smith said West Virginia, Tennessee and Arkansas are the only other states that have done such commercial PBM reform and "Ours is the most comprehensive."

"I think it's the strongest commercial PBM reform bill in the country and I think it will be the model for a lot of other states," she said.  

Wise said, "I'm very proud of this bill. I've carried some pharmacy bills in the past; this was the toughest one I've ever dealt with before. I'm hoping it will solve a lot of the issues." 

But he added that it's time for Congress to tackle the issue on a federal level. To his point, Smith said, "We still have work to do on the federal level and we are going to be involved in that."

Respiratory-virus activity ticks up a bit, but hospital admissions fall; flu remains driver for respiratory admissions, ER visits in Ky.

State Department for Public Health graphs, adapted by Kentucky Health News

By Melissa Patrick
Kentucky Health News

The state Department for Public Health says respiratory virus activity ticked up a bit in Kentucky in the last week of March, but remained at a relatively low level, while hospitalizations for respiratory disease declined but remained at a level that the department considers moderate. 

In the week ended March 30, emergency-room visits for influenza, Covid-19 and respiratory syncytial virus (RSV) increased almost 5% to 1,796. Of those, 1,508 were for the flu. 

But in that same week, hospital admissions for the diseases dropped 19%, to 233.  Of those, 135 were for flu, 85 were for Covid-19 and 13 were for RSV. 

In the week ended March 30, every Kentucky county had a low rate of Covid-19 hospital admissions, considered to be less than 10 admissions per 100,000 people by the Centers for Disease Control and Prevention. 

The state reported 1,431 laboratory-confirmed cases of the flu in the week ended March 30, showing the first uptick in confirmed flu cases since mid-February. The state reported 857 lab-confirmed cases of Covid-19, which have declined for seven weeks in a row.  

The Kentucky Respiratory Disease Dashboard is now reporting Kentucky monthly death information for all Kentuckians since October 2023 as well as a separate category for those 65 and older during the 2023-24 respiratory season. 

The dashboard shows that since the flu season began in October,  there have been a total of 524 deaths attributed to Covid-19, with 447 of them in people 65 and older. One Covid-19 victim and one flu victim were children. There have been 121 flu-related deaths, with 74 in people 65 and older. Ten deaths have been attributed to co-infection, with two of in people 65 and older.

UK researcher wins $3.1 million grant to study proteins that go haywire and lead to dementia; one goal is early treatment of it

Maj-Linda Selenica, Ph.D., works in her lab on March 27, 2024. (UK photo by Carter Skaggs)

By Hilary Smith
University of Kentucky

A University of Kentucky professor has received a $3.1 million grant from the National Institute on Aging to continue her research that she thinks could lead to treatments for early dementia.

Maj-Linda Selenica, Ph.D., assistant professor in the UK College of Medicine and associate director of outreach and partnerships at UK’s Sanders-Brown Center on Aging, has been working on research surrounding misfolding of the protein TDP-43, which is common feature of many neurodegenerative diseases, including Alzheimer's disease.

The condition is found in 1 in 5 people over 80. When severe it is associated with episodic memory loss, mimicking Alzheimer's-type dementia, and hastens the cognitive decline in patients with co-existing Alzheimer's pathology, 

Proteins that fold into a different, incorrect shape than their normal functional form are often unable to perform their normal functions and can even become toxic to cells. They can clump, which can lead to neurodegenerative diseases like Alzheimer's.

“We have uncovered completely novel modification of TDP-43 that uniquely and irreversibly changes the cellular mechanisms in the brain,” said Selenica.

Scientists have few strategies to intervene in the disease process, but Selenica and her lab have discovered that peptidyl arginine deiminases (PADs) promote the conversion of amino acid arginine in TDP-43 to the amino acid citrulline. This process, called citrullination, modifies TDP-43 and may be a potential therapeutic target.

Selenica began her research at the University of South Florida, where her team made novel antibodies for the citrullinated TDP-43, which did not exist as research tools. The team was able to use these antibodies to start looking at the potential mechanisms.

“Alzheimer’s disease brains and dementia brains undergo longstanding stress, so we asked the same thing of the cellular models and cross-validated our findings in animal models,” said Selenica. “We obviously cannot mimic what happens in the human brain, but these models permit us to understand mechanisms that underlie the human disease.”

Selenica’s lab collaborated with Sanders-Brown’s Daniel Lee, an associate professor in the UK College of Medicine and co-investigator on the grant. He was first to investigate the effects of PAD-dependent tau citrullination in Alzheimer's. Their efforts now focus on better understanding how citrullination impacts TDP-43 and other proteins.

The terms “Alzheimer’s disease” and “dementia” are no longer interchangeable. Now scientists understand that a variety of diseases and disease processes contribute to dementia, which is why so much of the ongoing work within the labs at Sanders-Brown are connected in some way. Selenica and Lee’s laboratories are joining forces to focus on two prominent pathological hallmarks in dementia-related diseases.

Selenica’s colleague, Dr. Pete Nelson, a professor of pathology and laboratory medicine at UK and leader of neuropathology at Sanders-Brown, led a group of international experts who characterized TDP-43 effects as a new form of dementia. 

Selenica collaborated with Nelson to look at human brain tissues from the UK Alzheimer’s Disease Center Tissue Bank in Sanders-Brown. Nelson is also a co-investigator in this new grant.

Based on her research and the work that planned under the new NIA grant, Selenica is hopeful it can result in several therapeutic avenues to target TDP-43 early in the disease development process.

 “I’m hoping that several years from now we can develop disease-modifying therapeutic strategies and future biomarker assays targeting TDP-43 pathology,” Selenica said. And she doesn’t think the work will stop there. “I think this project will open the field to much more fruitful collaborations. It has us really thinking about, could we develop something to target all the pathologies at once?”

How to protect your eyes while watching Monday's solar eclipse

NASA map, adapted by Kentucky Health News

Journal of the American Medical Association

On Monday, April 8, a solar eclipse will pass over Mexico, the U.S., and Canada. The eclipse will be total in parts of Kentucky along the lower Ohio and Mississippi rivers. In Paducah, totality will last about 1 minute and 45 seconds, starting just after 2 p.m. Central Time; in Henderson, it will last 2 minutes and 10 seconds, starting at 2:02 p.m. CT. Maximum totality, at the center of the eclipse path, will exceed 4 minutes. A NASA map is here.

A total solar eclipse occurs when the moon completely blocks the view of the sun in a narrow path across the earth’s surface. In a partial solar eclipse, the moon only partially blocks the sun, so it can be observed an area that is thousands of miles wide. But clouds can obscure it; the National Weather Service is updating Monday's cloud forecast daily.

What Are the Dangers of Watching a Solar Eclipse? Watching a solar eclipse without proper eye protection can cause vision loss, including blindness, due to burning of the macula, which is part of the retina, the light-sensitive tissue at the back of the eye that enables people to read and recognize faces. Some individuals mistakenly believe that it is safe to view a total eclipse without eye protection during the time when the moon completely blocks the sun. However, totality of this eclipse will last from a few seconds to more than 4 minutes, based on geographic location, and bright sunlight will suddenly appear as the moon moves. Even a few seconds of viewing the sun can temporarily or permanently burn the macula. Once retina tissue is destroyed, it cannot regenerate, resulting in permanent central vision loss.

Safe Ways to Watch a Solar Eclipse: Exact times and locations of the upcoming solar eclipse can be found at science.nasa.gov/eclipses/future-eclipses/eclipse-2024/where-when/. Worldwide, 8 total solar eclipses will occur in the next decade.

Never view the sun or a total solar eclipse with the naked eye or by looking through binoculars, telescopes, or a phone camera. Sunglasses alone also are not safe. Make sure to supervise children using solar filters. Some safe ways to view an eclipse include:

• Direct viewing through shade No. 14 welder’s glasses
• Direct viewing through aluminized Mylar filters: These plastic sheets can be used for viewing an eclipse but should be used only if totally intact, with NO scratches.
• Pinhole projector: Make a pinhole in a piece of cardboard; hold it in front of the sun just before the eclipse. With your back to the sun, focus the light going through the pinhole onto another piece of cardboard beyond the pinhole so that you see the sunlight focused onto the second piece of cardboard. As the eclipse occurs, you can see the focused sunlight become blocked by a dark circle (the shadow of the moon). Look only at the image on the paper. Do not turn around and view the eclipse with the naked eye.

A list of recommended solar filter vendors can be found at the American Astronomical Society’s website.

If Vision Loss Occurs After Viewing a Solar Eclipse: Individuals with vision loss after viewing a solar eclipse should promptly visit an ophthalmologist, an eye doctor who can recognize symptoms and signs of solar burns on the retina. The diagnosis might be made on clinical evaluation or with diagnostic tests such as optical coherence tomography, a noninvasive imaging technique that can identify solar damage to the retina. There is no definitive treatment other than observation; sometimes individuals have partial recovery of vision.

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.

Republicans talk about making Obamacare better, not repealing it, so it is 'becoming a politically untouchable part' of the safety net

Washington Post graph from Kaiser Family Foundation polling data

Kentucky Health News

"A law once derided as 'Obamacare' and demonized as a big-government power grab is becoming a politically untouchable part of the American safety net, like Social Security and Medicare before it," writes Dan Diamond, lead health reporter for The Washington Post.

As evdience, Diamond cites President Joe Biden's "celebration" of the Patient Protection and Affordable Care Act as he runs for re-election, and former president Donald Trump's "grudging acceptance" of the 2010 law: he no longer wants to repeal it, just "make it better."

In Kentucky, where then-Gov. Steve Beshear embraced Obamacare by expanding Medicaid to the point that it covers every third person in the state, Republicans have realized its political appeal and have not pushed to replicate the failed efforts of Republican Matt Bevin, governor in 2015-19, to impose work requirements on Medicaid beneficiaries.

Nationally, "More than 45 million people now rely on the ACA and its provisions for health coverage, according to a federal report released last week, and the law’s protections for people who have pre-existing conditions have transformed many Americans’ experience of health care. Yet for nearly a decade, Republicans like Trump successfully ran on pledges to 'repeal Obamacare' — and Democrats sometimes ran from it, scarred by the law’s bumpy rollout, the constant political attacks and the struggle to communicate its benefits," Diamond notes. "But when Trump and his Republican allies nearly repealed the ACA — falling one senator short in July 2017 — it sparked passionate efforts to defend it and catalyzed new, long-lasting support."

Between the time Trump was elected and took office, outgoing Health and Human Servcies Secretary Sylvia Burwell "rolled out a 70-day crash plan to shore up support for the health law, developing targeted maps to show members of Congress how the law was affecting their communities," Diamond reports. "She worked the phones to reach GOP lawmakers and governors, seeking promises that they would not cut the protections for people with pre-existing conditions — one of the most beloved parts of the law, and one of the most integral. Burwell knew preserving that provision would complicate the ability to repeal the broader ACA. . . . Ultimately, Sen. John McCain (R-Ariz.) blocked the repeal in a dramatic late-night vote," killing a so-called "skinny repeal" bill sponsored by Republican Leader Mitch McConnell of Kentucky.

As Sen. Mitch McConnell watched, Sen. John McCain turned thumbs down and voted "no" on the bill.

"Today, more Americans than ever have health coverage, with about 21 million insured through the ACA’s private health plans, up from 12 million when Biden took office, according to a federal report released last week," Diamond reports. "Another 23 million gained coverage through the law’s expansion of the Medicaid program."

Sports betting has taken off in Kentucky, but counselors for people with a gambling disorder remain in short supply in the state

Churchill Downs Race and Sports Book opened in downtown Louisville in September. (J. Munoz, LPM)

By Jacob Munoz
Louisville Public Media

Legal sports wagering launched in Kentucky in September. Residents can bet online and at brick-and-mortar venues like horse racetrack facilities, no longer needing to cross state lines.

Some experts say the wide legalization and promotion of sports betting could present risks, especially around addiction. The American Psychiatric Association recognizes gambling disorder and defines it as someone showing at least four deeply harmful habits in a year. Those can include constantly thinking about gambling, trying to recoup lost money by gambling more, and being unable to quit.

RonSonlyn Clark is a licensed gambling counselor and the president of the Kentucky Council on Problem Gambling, an advocacy group that connects people struggling with gambling to resources like therapy. She said the accessibility of sports betting can cause a gambler to fall “deeper and deeper into trouble”, and Kentuckians who live far from other states where gambling has been legalized are now at greater risk.

“You can sit in the comfort of your home, while your family is sitting there watching TV at night — most people are playing on their phones — and you can be placing sports bets at any time,” Clark said.

The International Gambling Counselor Certification Board lists Clark as just one of three active counselors in Kentucky, and her organization is looking to boost that number by hosting training sessions. She said she treats patients “from across the state.”

“Because there are so few of us, I do use some telehealth resources,” said Clark, who is based in Owensboro.

The council lists several other certified counselors in the state. Mike Stone, the group’s executive director, said that’s because some earned certification before a merger between the American and International boards.

Calls in Kentucky to a national gambling helpline, answered at RiverValley Behavioral Health in Owensboro, have increased since the state launched sports wagering in September. Gerrimy Keiffer, who works at RiverValley, said in an email that during the first two months of 2024, there were 101 calls seeking help or information on harmful gambling.

Stone attributed the rise in calls to the emergence of sports-betting ads that include the helpline number. He added that legalization has coincided with a shift in what callers say is their preferred method of gambling.

“It has been for years back and forth between lottery scratch-offs and slot machines at casinos. … For the first time in January, the preferred game of choice was sports betting,” Stone said.

An analysis by the council released in 2022 estimated that at least 47,000 Kentuckians could have a gambling addiction, which studies have shown correlates with a high risk of suicide. The council’s analysis also found that at least 102,000 more residents could be at risk of addiction.

Clark said the state has been late in addressing the harms connected to gambling. “I think we should have been focused on problem gambling 25 years ago, when we started” the council, she said.

Guardrails and gaps

Kentucky’s approval of sports betting included a goal to support the state’s permanent pension fund. Revenue from wagers placed at brick-and-mortar venues is taxed at 9.75%, a rate that jumps to 14.25% for online bets.

While some Republicans in the GOP-dominated legislature objected to it on moral grounds, others framed it as a way to regulate an underground industry and prevent residents’ money from going into neighboring states that had already legalized the practice.

Jim Whelan, executive director of the Tennessee Institute for Gambling Education and Research, said that when states legalize the practice, they’re able to better mitigate longstanding risks linked to gambling: “Before the lottery, the idea that you would do public awareness about gambling harms, legislators [and] regulators wouldn't touch.”

Kentucky’s law to legalize sports betting also gave regulatory powers to the Kentucky Horse Racing Commission, an independent state agency. In the last three regular days of their legislative session, Kentucky legislators passed a bill to replace the Horse Racing Commission and the Department of Charitable Gaming with a new regulatory agency to oversee most forms of legal gambling.

Through an emergency amendment last year, the commission set some rules on sports wagering advertisements — including banning them at grade schools — and set up a self-exclusion list that residents can opt into if they believe they have a gambling problem. Sports betting providers can’t offer wagering to people who self-exclude from their product for a set amount of time.

In Kentucky, sports betting runs through racetracks such as Churchill Downs and Keeneland Race Course, which can then partner with sportsbook providers. Regulations require the tracks to regularly report self-exclusions they receive to the commission, which shares the full list with all of them.

But those regulations don't require the tracks and their sportsbooks to prohibit everyone on the list from their betting services. The rules also don’t specify how long Kentuckians should be able to self-exclude from gambling beyond at least a 72-hour “break.” Sports-betting providers offer those short cutoffs alongside longer self-exclusion periods.

At least several providers that operate in Kentucky let residents self-exclude for up to five years, and they don’t reopen accounts unless a user requests it. But the majority don’t say they allow for permanent self-exclusion.

Sharon Custer is concerned that people who opt out temporarily could redevelop unhealthy habits once that period is over. She’s a faculty member at the Institute for Responsible Gaming, Lotteries and Sport at Miami University in Ohio, which makes policy recommendations for gambling industries.

Custer said she likes that Kentucky has a shared self-exclusion list, but wants to see more regulations in place: “It should make it a little bit hard to [re-enter], so that someone really has to think twice, ‘Is this really what's best for me?’”

Some states like Ohio and New Jersey have government programs that allow residents to self-exclude from all sports wagering services, and from other forms of gambling, but Kentucky does not.

Rachel Volberg, a research professor at the University of Massachusetts-Amherst and president of the gambling consulting firm Gemini Research, said that a “strong, independent regulator” is necessary to oversee the gambling industry.

She pointed to the Massachusetts Gaming Commission, a public agency that hired her more than a decade ago to lead an ongoing research project into gambling’s social and economic impacts on the state.

“Gambling regulation is increasingly being viewed as not just about making sure the operators follow the rules to offer a product in a fair and transparent way,” Volberg said, “but also preventing those operators from behaving in ways that are going to cause harm to residents.”

The Kentucky law legalizing sports wagering also established a fund that provides money for people and groups seeking to address unhealthy gambling behaviors. Those funds can be used for activities like public awareness campaigns, gambling counselor trainings and addiction treatment cost support.

The fund receives 2.5% of the collected tax revenue from sports betting. According to the commission, nearly $900 million had been placed on wagers from Sept. to Dec. 2023. That produced more than $15.5 million in tax revenue, on pace to exceed officials’ expectations of $23 million in year one.

Brice Mitchell, a spokesperson for the state Cabinet for Health and Family Services, said about $630,000 has been deposited in the gambling-assistance account after about half of a year of legal sports betting.

A need for resources

The federal government provides funding, resources and training toward addressing substance abuse and mental health issues. But that doesn’t include support for unhealthy gambling.

Whelan, of the Tennessee Institute for Gambling Education and Research, said there aren’t enough resources to treat unhealthy gambling behaviors: “There's not a lot of education being done out there for health service providers, on how to provide treatment, or even how to screen for this. The issue really comes back to money.”

While some research has shown that medicine, such as opioid antagonists, can address people’s symptoms from a gambling disorder, the U.S. Food and Drug Administration has yet to approve any drugs for treatment. Whelan said that behavior-based solutions that target gambling work.

Gamblers are “fundamentally different,” Whelan said, referencing a common belief that they can solve their issues by having “one big win.” He added, “That cognitive behavioral treatment needs to be tailored to the culture and the kind of processes that happen for people when they gamble.”

Clark, of the Kentucky Council on Problem Gambling, said her group hasn’t decided if they will apply for money in the state fund. They hosted a certification session for about 20 people in January.

“This is the first time we’ve had this much interest in becoming a gambling counselor … in a very long time,” Clark said.

She stressed that her group is neutral on gambling itself, and that it can be a healthy practice in moderation: “Gambling is supposed to be fun and entertaining. Take some money that you would use for a night of any other entertainment … That can be the gambling money.”

But she said that people shouldn’t double down on making a profit from it: “Places like Las Vegas, and the casinos and the racetracks, they’re all beautiful, beautiful venues. They didn't build those places off of people's winnings. They built those off of people's losses in those communities.”

If you or someone you know is at risk of problems related to gambling, the national helpline 1-800-GAMBLER can provide resources.

Paxlovid is effective against Covid-19, but many people eligible for it are not getting it; it's free to Medicare and Medicaid beneficiaries

Getty Images

By Dr. Nicholas Van Sickels

University of Kentucky

A safe and effective medication designed to prevent mild to moderate Covid-19 infections from becoming more dangerous has been available for almost two years. But recent studies have shown many patients eligible for the drug – Paxlovid – haven’t been prescribed it.

In a clinical trial, the orally taken medication reduced the risk of hospitalization and death by 86 percent. Paxlovid was fully approved by the Food and Drug Administration in May 2023 but has been available through an emergency-use authorization since 2022.

A pre-print study of over a million Covid-19 patients found that less than 10% of eligible patients were prescribed Paxlovid, also known as nirmatrelvir-ritonavir. The reasons behind the treatment’s slow uptake could include confusion over who’s eligible or even unfamiliarity with the drug.

How does it work? The antiviral drug works to stop the replication of the virus which causes Covid-19 at the cellular level. It comes as a dose pack; two of the pills are the active medicine, nirmatrelvir, and one is a “booster” medicine, ritonavir, which helps the nirmatrelvir maintain effective levels in the bloodstream.

Paxlovid is most effective when taken within five days of developing symptoms.

Who’s eligible? The treatment is designed for high-risk patients who have a mild or moderate case of Covid-19 but hope to avoid more severe consequences. You might be considered high-risk if you’re:

• Over 50
• Not up to date on COVID vaccinations
• Immunocompromised
• Pregnant
• Have any other medical conditions like diabetes, hypertension or asthma

A full list of medical conditions that may leave you at high-risk for a severe case of COVID-19 are listed on the CDC’s website here.

When should I ask my doctor about Paxlovid? If you are at high-risk for complications from Covid-19, it’s best not to wait before asking your doctor about Paxlovid. The treatment should be taken within five days of the onset of symptoms.

A study from the University of Hong Kong, which analyzed data from over 87,000 patients who took nirmatrelvir-ritonavir, found that earlier treatment within that five-day window leads to better outcomes.

The treatment will be free for Medicare or Medicaid beneficiaries through the end of 2024 via the U.S. government’s Patient Assistance Program. Those with private insurance can enroll in the Paxcess program to help lower out-of-pocket costs.

When you ask your health care provider about Paxlovid, make sure to update them on all other medications you are taking. While most medications are generally safe to take with Paxlovid, there are some which need dose adjustments or should be held during and for a short while after treatment. On very rare occasions, treatments other than Paxlovid are needed for people at high-risk for complications from Covid-19 who take certain medications.

How can I best protect myself from Covid-19? Improvements in how Covid-19 is prevented and treated have led to a relative relaxation in guidance on how to avoid the virus. In early March, the Centers for Disease Control and Prevention began to group its Covid-19 guidelines with other diseases caused by respiratory viruses such as flu and respiratory syncytial virus.

The basic guidelines around avoiding respiratory viruses include:

• Staying up to date on your immunizations
• Practicing good hygiene like proper handwashing or covering coughs
• Access cleaner air by opening windows or gathering outdoors

If you get sick with a respiratory virus, it’s best to stay home and away from others.

Nicholas Van Sickels, M.D., is director of infection prevention and control at UK HealthCare.