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 201 (see companion bill SB 250) – Kentucky
Introduced: 2021 Status: Enacted
AN ACT relating to contraceptive coverage. Create a new section of Subtitle 17A of KRS Chapter 304 to define terms; require health benefit plans to provide coverage for contraception; set forth requirements for health benefit …
HB 202 – Kentucky
Introduced: 2024 Status: In Process
Amend KRS 216B.015 to amend the definition of “capital expenditure minimum” and define “major medical equipment expenditure minimum”; amend KRS 216B.061 to modify conditions under which a person is prohibited from taking actions without a …
HB 203 – Kentucky
Introduced: 2024 Status: In Process
Amend KRS 216B.020 to add various health facilities and services to the list of health facilities and services that are exempt from certificate of need requirements; amend KRS 216B.065 to exempt various health facilities and …
HB 204 – Kentucky
Introduced: 2024 Status: In Process
This bill pertains to amendments in the existing regulations related to the Certificate of Need (CON) in the healthcare sector in the state of Kentucky. The CON is a legal document required in many states, …
HB 220 – Kentucky
Introduced: 2019 Status: Enacted
Create a new section of Subtitle 3 of KRS Chapter 304 to require insurers to file Corporate Governance Annual Disclosures with the Department of Insurance; specify the form and contents of the disclosures; allow insurers …
HB 311 – Kentucky
Introduced: 2023 Status: Enacted
Amend KRS 205.559 to prohibit the Department for Medicaid Services and any Medicaid managed care organization from requiring that a health professional or medical group maintain a physical location or address in this state to …
HB 95 – Kentucky
Introduced: 2021 Status: Enacted
Retain original provisions; delete provision prohibiting an insurer with a cost-sharing requirement of less than $30 for a 30 day supply of prescription insulin on the effective date of this Act from increasing that cost-sharing …
Ky. Rev. Stat. § 18A.225. Health care insurance coverage; requirements of prospective carriers; analysis of carrier coverage data; agency’s termination of participation; provision of amount of employer contribution; lapse of excess flexible spending account funds; appeal of formulary change; retiree’s participation; mail order drug option coverage; hearing aid coverage for minors; coverage for diagnosis and treatment of autism spectrum disorders; amino acid-based elemental formula coverage; access to certain services in contiguous counties; study of bid variation; regional rating bid scenario; optometric coverage; nondiscrimination against provider in geographic coverage area; standards for provider participation; utilization review; payment of claims; uniform health insurance claim forms; emergency medical care; administrative regulations (Effective July 1, 2019): Health Coverage – Kentucky
Introduced: Status: Enacted
The Personnel Cabinet is encouraged to study whether it is fair and reasonable and in the best interests of the state group to allow any carrier bidding to offer health care coverage under this section …
Download
Ky. Rev. Stat. § 18A.2254. Self-insured plan for public employees; contract for third-party administrator; formulary change; health reimbursement account, health flexible spending account, or health savings account; public employee health insurance trust fund; annual audit; quarterly status reports: Health Coverage – Kentucky
Introduced: Status: Enacted
The plan year handbook for self-insured plans shall contain the premiums, employee contributions, employer contributions, and a summary of benefits, copays, coinsurance, and deductibles for each plan.
Download
Ky. Rev. Stat. § 194A.103. Division of Health Information created in the Office of Health Data and Analytics – Division to provide leadership in the redesign of the health care delivery system – Administrative regulations: Health Coverage – Kentucky
Introduced: Status: Enacted
The division shall provide leadership in the redesign of the health care delivery system using electronic information techonology as a means to improve patient care and reduce medical errors and duplicative services.
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.