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.
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. § 205.559. Requirements for Medicaid reimbursement to participating providers for telehealth consultations; report of impact on health care delivery system required; administrative regulations (Effective until July 1, 2019): Medical Assistance (State Medicaid Program) – Kentucky
Introduced: Status: Enacted
The Cabinet for Health and Family Services and any entity under contract with the cabinet for the administration or provision of the Medicaid program shall provide Medicaid reimbursement for a telehealth consultation that is provided …
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Ky. Rev. Stat. § 205.5591. Medicaid providers using telehealth; duties of cabinet and managed care organizations; reimbursement for covered services; administrative regulations; deductible, copayment, and reinsurance requirements; policies and guidelines: Medical Assistance (State Medicaid Program) – Kentucky
Introduced: Status: Enacted
The cabinet shall provide oversight, guidance, and direction to Medicaid providers delivering care using telehealth. The Medicaid program or a Medicaid managed care organization shall reimburse for covered services provided to a Medicaid recipient through …
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Ky. Rev. Stat. § 205.6310. Cabinet to establish system to reduce unnecessary hospital emergency room utilization and costs: Miscellaneous Health Coverage Provisions – Kentucky
Introduced: Status: Enacted
The Cabinet for Health and Family Services shall establish a system within the Medical Assistance Program to reduce unnecessary hospital emergency room utilization and costs by redefining and controlling hospital emergency utilization.
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Ky. Rev. Stat. § 205.6312. Medical recipients to pay allowable nominal copayments – Administrative regulations: Miscellaneous Health Coverage Provisions – Kentucky
Introduced: Status: Enacted
The cabinent shall institute nominal copayments or similar charges to be paid by medical assistance recipients, their spouses, or parents.
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Ky. Rev. Stat. § 205.6314 Review of reimbursement rates for emergency transportation providers; promulgation of administrative regulations relating to emergency transportation providers: Miscellaneous Health Coverage Provisions – Kentucky
Introduced: Status: Enacted
The Cabinet for Health and Family Services shall review the Medical Assistance Program reimbursement rates for emergency transportation providers to determine if existing rates are fair and reasonable.
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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
Annual appropriations are made in the biennial budget bills. The state’s fiscal year begins July 1 and extends to the following June 30. To view Kentucky’s operating budget on health and family services, visit pages here.
REGULATION & ENFORCEMENT
- Kentucky was one of 16 states to file an amicus brief supporting the FTC’s winning position in the Ninth Circuit appeal of St. Luke’s Health Care Sys. v. FTC, No. 14-35173 (March 7, 2014), decided February 10, 2015. The States’ brief stated that the acceleration of health care costs due to the growth of large health care provider systems had become a matter of grave concern for the states.
KEY RESOURCES