By PJ Martin
Several new Kentucky Revised Statutes (KRS) amendments went into effect on January 1, 2022, of those many were concerning healthcare benefits, but perhaps the biggest win comes for people suffering from diabetes.
House Bill 95 amends KRS 304-17A.148 to cap the cost-sharing requirements for prescription insulin to not exceed $30 per 30-day supply no matter what type or amount of insulin is prescribed. Also amended is KRS 18A.225 to require the Kentucky Employee Health Plan to comply.
The price cap applies to people with state-regulated health care plans or plans purchased on the marketplace exchange, state employees, and people under group plans.
The amendment includes coverage for equipment, supplies, outpatient self-management training, and education, including medical nutrition therapy, and all medications necessary for the treatment of insulin-dependent diabetes, insulin-using diabetes, gestational diabetes, and noninsulin-using diabetes if prescribed by a health care provider who is certified, registered, or licensed health care professional.
Senate Bill 45 amends KRS 304.17A-164 to allow costs paid for medications over the amount allowed by the drug coverage to be calculated in the yearly deductible and out-of-pocket totals. It also states that the insured does not pay an amount greater than they would if they were non-insured.
However, these do not apply in the case of a prescription drug with a generic alternative. If the patient has received special brand necessity documentation from their doctor, they have gone through the steps of drug therapy required, or the appeals process, these medications should be covered.
House Bill 140 creates new sections of KRS Chapter 211 to define and establish standards and requirements for the use of telehealth services. It requires the Cabinet for Health and Family Services and managed care organizations to reestablish requirements and to study the impact of telehealth on the state’s health care delivery system, prohibit certain practices in telehealth, and authorize the licensing of health practitioners.
Also amended is KRS 205.559 requiring reimbursement rates for telehealth to be equivalent to reimbursement rates for the same service provided in person for Medicaid services.
In summary, the doctor or hospital must offer telehealth appointments as an option for your care just as they would an in-person appointment and states that telehealth appointments will be paid for by the insurance just as if it were an in-person visit. However, there are many requirements for the provider to follow.
If you would like to view any of the bills mentioned in full, or the Kentucky Revised Statutes you can visit the following websites: https://apps.legislature.ky.gov/law/statutes, or