Overview
The Kentucky legislature has consistently pursued legislation aimed at improving access to healthcare price information to help rein in costs. In recent terms, Kentucky has enacted a number of legislation pertaining to prescription drug cost transparency, with particular focus on pharmacy benefit managers, including a law that prohibits PBMs from requiring drug payments in excess of required amounts (“clawbacks”) and from preventing a pharmacy’s disclosure of more affordable cost options to consumers (“gag clauses”). Another statute provides transparency in Medicaid Managed Care Organizations (MCOs) reimbursements by enforcing additional PBM reporting requirements and giving broader, direct oversight and approval by the Kentucky Department of Medicaid Services. Other noteworthy yet unsuccessful price transparency proposals have included a ban on surprise billing, establishment of an all-payer claims database, and implementation of shared savings incentive programs.
In the provider market, Kentucky requires a Certificate of Need (CON) prior to the acquisition of a health facility or major medical equipment. The state’s CON process requires providers to file a notice of intent that includes a description of the services to be offered, bed capacity, and use of medical equipment in the facility. To further curb anticompetitive behavior in the healthcare market, Kentucky law also prohibits most favored nation clauses in provider contracts except in cases where the commissioner determines the market share of the insurer is nominal.
Kentucky has also enacted laws to incentivize health professionals to provide telehealth services. The state requires health insurance plans to provide parity for coverage, reimbursement, and cost-sharing of telehealth services on at least the same basis as in-person services.
In 2024, the state legislature looked at a number of bills addressing certificate of need, and prior authorization.
See below for an overview of existing Kentucky state mandates. Click on citation tab for detailed information of specific statutes (click link to download statute text).
State Action
Latest Legislative Session: 1/5/2021 - 3/30/2021 (2021 term). *Current session bill updates are ongoing. Check back weekly for updates.
HB 108 – Kentucky
Introduced: 2021 Status: Enacted
AN ACT relating to the codification of existing Medicaid cancer coverage. Amend KRS 205.522 to require the Department for Medicaid Services and any managed care organization contracted to provide Medicaid benefits in the Commonwealth to …
HB 114 (see companion bill SB 45) – Kentucky
Introduced: 2021 Status: Inactive / Dead
Amend KRS 304.17A-164 to redefine “cost-sharing” and define “generic alternative,” “health plan,” “insured,” and “person”; prohibit an insurer or pharmacy benefit manager from excluding any cost-sharing amount paid by or or behalf of an insured …
HB 117 – Kentucky
Introduced: 2021 Status: Inactive / Dead
AN ACT relating to coverage for the mailing or delivery of covered prescription drugs: Create a new section of Subtitle 17A of KRS Chapter 304 to require health benefit plans that provide benefits for prescription …
HB 12 (see companion bill SB 112) – Kentucky
Introduced: 2018 Status:
AN ACT RELATING TO TELEHEALTH. Create a new section of KRS Chapter 205 to require the cabinet to regulate telehealth; set requirements for the delivery of telehealth services to Medicaid recipients; require equivalent reimbursement for …
HB 121 – Kentucky
Introduced: 2019 Status: Inactive / Dead
Amend KRS 304.17A-611 to prohibit insurers from setting requirements or using certain utilization reviews for certain prescription drugs used to treat opioid use disorder; amend KRS 205.536 to prohibit the Department for Medicaid Services or …
Ky. Rev. Stat. § 304.17A-0954. Definitions for section; premium rate guidelines for employer-organized association plans: Health Benefit Plans — Miscellaneous Provisions – Kentucky
Introduced: Status: Enacted
The amount or rate of premiums for an employer-organized association health plan may be determined based upon the experience or projected experience of the employer-organized associations whose employers obtain group coverage under the plan.
Download
Ky. Rev. Stat. § 304.17A-138. Telehealth coverage and reimbursement – Requirements for health benefit plan – Benefits subject to deductible, co-payment, or coinsurance; Payment subject to provider network arrangements; Administrative regulations: Health Benefit Plans — Miscellaneous Provisions – Kentucky
Introduced: Status: Enacted
A health benefit plan shall reimburse for covered services provided to an insured person through telehealth as defined in KRS 304.17A-005. Telehealth coverage and reimbursement shall be equivalent to the coverage for the same service …
Download
Ky. Rev. Stat. § 304.17A-150. Unfair trade practices; penalties: Health Benefit Plans — Miscellaneous Provisions – Kentucky
Introduced: Status: Enacted
It is an unfair trade practice for an insurer or any other person in the business of marketing and selling health plans to encourage individuals or groups to refrain from filing an application for coverage …
Download
Ky. Rev. Stat. § 304.17A-162. Identification of sources used to calculate drug product reimbursement; process to appeal disputes over maximum allowable cost pricing; adjustment of maximum allowable cost and drug product reimbursement; duties of pharmacy benefit manager: Health Benefit Plans — Miscellaneous Provisions – Kentucky
Introduced: Status: Enacted
A pharmacy benefit manager shall identify to contracted pharmacies the sources used by the pharmacy benefit manager to calculate the drug product reimbursement paid for covered drugs available under the pharmacy health benefit plan administered …
Download
Ky. Rev. Stat. § 304.17A-173. Reimbursement for services within scope of practice of optometrists; terms and conditions: Health Benefit Plans — Miscellaneous Provisions – Kentucky
Introduced: Status: Enacted
Any insurer issuing or renewing a health benefit plan issued or renewed on or after July 12, 2006, which provides coverage for services rendered by a physician or osteopath duly licensed under KRS Chapter 311 …
Download
Federal Trade Commission and State of Idaho v. St. Luke’s Health System, Ltd and Saltzer Medical Group, P.A. – California, Connecticut, Delaware, Idaho, Illinois, Iowa, Kentucky, Maine, Maryland, Mississippi, Montana, Nevada, New Mexico, Oregon, Pennsylvania, Tennessee, Washington
District Court: District of Idaho Status: Decided
In March 2013, the FTC and the Idaho Attorney General filed a joint complaint challenging the merger betweenSt. Luke’s Health System, Idaho’s largest health system, …
In re: Suboxone Antitrust Litigation (State of Wisconsin, et al. v. Indivior Inc, et al.) – Alabama, Alaska, Arkansas, California, Colorado, Connecticut, Delaware, District of Columbia, Florida, Georgia, Hawaii, Idaho, Illinois, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Nebraska, New Hampshire, New Mexico, New York, North Carolina, Ohio, Oklahoma, Oregon, Pennsylvania, South Dakota, Tennessee, Utah, Virginia, Washington, West Virginia, Wisconsin
District Court: E.D. Pennsylvania Status: Pending
In September 2016, 35 state attorneys general and the District of Columbia brought a multi-district case against pharmaceutical manufacturer Indivior, MonoSol RX et al., alleging …
In Re: Generic Pharmaceuticals Pricing Antitrust Litigation – Alabama, Alaska, Arizona, Arkansas, California, Colorado, Connecticut, Delaware, District of Columbia, Florida, Hawaii, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, South Carolina, Tennessee, Utah, Vermont, Virginia, Washington, West Virginia, Wisconsin
District Court: Eastern District of Pennsylvania Status: Pending
Plaintiffs are attorney generals from 48 states, Puerto Rico, and the District of Columbia, as well as classes of private plaintiffs that filed an antitrust …
Additional Resources
STATE BUDGET
The state operates on a biennial budget cycle. State agencies submit their budget requests by November 15 of the year preceding the start of the biennium. The Governor submits the proposed budget to the Legislature 10 legislative days after it convenes in early January. The state Legislature adopts a budget in April, with the biennium beginning July 1.
STATE LEGISLATURE
There are 38 state Senators serving four-year terms. The 100 members of the state House of Representatives serve two-year terms. The Legislature convenes on the first Tuesday after the first Monday in January. In even-numbered years, sessions may not last more than 60 legislative days, and cannot extend beyond April 15. In odd-numbered years, sessions may not last more than 30 legislative days, and cannot extend beyond March 30. Bills do not carry over from year to year.