Pill-mill bill passes; attorney general won't get drug-monitoring system but narcotic-prescribing doctors will have to use it

House Speaker Greg Stumbo, center, walks
with House budget committee chair Rick
Rand and House Majority Floor Leader
Rocky Adkins. (Courier-Journal photo).

Legislators have sent Gov. Steve Beshear a bill to curb prescription drug abuse and crack down on rogue pain clinics, ending the special session of the General Assembly.

The final version left the state's prescription drug-monitoring system under the control of the Cabinet for Health and Family Services and the doctor-controlled Kentucky Board of Medical Licensure rather than move it to the attorney general's office, as the last version in the regular session would have. But in another significant change, it will require doctors and pharmacists who prescribe or dispense Schedule II and III drugs, such as oxycodone and morphine, to use the Kentucky All Schedule Prescription Electronic Reporting system. Only about 25 percent of Kentucky physicians now use KASPER.

Putting the drug-monitoring system in the hands of the attorney general was considered a linchpin of efforts to help law enforcement to proactively identify suspicious prescribers; law enforcement officers can access the database only if they have a case opened, and say they need the data to open cases. But the Kentucky Medical Association called giving law enforcement oversight of information with prescription-drug information a violation of personal privacy. "You are essentially legislating medical care," said Shawn Jones, president of the KMA.

Beshear, who repeatedly pressured legislators to pass a bill pertaining to the issue, issued a statement this evening expressing his delight. "Even though the prescription drug bill doesn't include every element we had hoped, it is an enormous bipartisan accomplishment, and it restores Kentucky as a leading state in innovative tactics in battling prescription drug abuse," he said. "The elements of the bill also help prevent Kentucky from becoming a source state for prescription pills.

House Speaker Greg Stumbo, who sponsored the bill, called its passage "a step forward" though he "would have preferred a stronger version." He told reporters that he did not feel this would be the last time lawmakers would be changing laws to fight the problem, and noted that Beshear could use his gubernatorial reorganization powers to change the administration of the system: "I think the governor, in the days ahead, will continue to take aggressive action on addressing this problem."

The measure will require pharmacists to submit information to KASPER within 24 hours of dispensing a narcotic and doctors must check the system before prescribing one to a new patient. They then would be required to check a KASPER report every three months during a patient's treatment.

As before, the measure will require most pain clinics be owned by at least one doctor; 33 of Kentucky's 77 pain clinics are owned by people with no medical background. Those who already own clinics and haven't had run-ins with the law will be "grandfathered" and be allowed to continue operating. "That really waters it down. A lot!!" Operation UNITE Director Karen Kelly said on Facebook.

Lawmakers also passed the transportation budget bill, which was the main reason why they were called in for a special session by Beshear. They reached an impasse last week when the Senate would not approve the budget, a move Beshear and Senate President David Williams blamed on each other.

There were suggestions that the road and drug issues, the only items that the legislature could consider under Beshear's call of the session, were related. "As the Senate receded on the amendment to put back $50 million of [road] money into Senate President David Williams' district, word went out that the House would compromise on the pill bill and let the Senate keep KASPER [where it is] as long as a funding change took place," Ryan Alessi reports for cn|2. "The Senate sprang into action amended the pill bill and leaders from the two chambers worked together to pass legislation before supper time."

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Fighting prescription drug abuse back on legislative agenda

As expected, finding a way to fight prescription drug abuse was back on the legislative agenda as lawmakers gathered for Day 1 of their special session. House Speaker Greg Stumbo introduced a bill today that will make it "mandatory for doctors to use the state's electronic reporting system for prescriptions, which would be moved from the Cabinet for Health and Family Services to the attorney general's office," report Jack Brammer and Beth Musgrave for the Lexington Herald-Leader.

Filed as House Bill 1, Stumbo said it "will correct damages caused by lobbyists for the Kentucky Medical Association in the final days of the regular session, when KMA inserted last-minute language that prevented mandatory use of this basic tool."

The bill also makes it possible for doctors who teach pain and addiction medicine at the University of Kentucky and University of Louisville to be appointed by the governor to the boards that license doctors and nurses. "The KMA's lobbyists can no longer argue that such experts do not exist or, if they do, that they should not be on the licensing boards," Stumbo said. "It is unfortunate that KMA lobbyists sought to obscure this provision."

The bill, slightly altered from House Bill 4 that did not pass before the end of the legislative session Thursday, is considered by experts to be the cornerstone of this legislative session. (Read more)

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Pill-mill bill does not pass as legislative session ends in failure; special session starts Monday

Though it's considered by experts as the most important bill needed this year, the Senate failed to pass a measure that would crack down on so-called pill mills before the end of the legislative session last night. Gov. Steve Beshear, above, called a special session that will begin Monday to give legislators more time to consider the bill, as well as approve funding for a $4.5 billion road-building plan — which was the main cause for the legislative gridlock.

Beshear wasn't happy, and blamed Senate President David Williams: "His rank partisanship, his obstructionist attitude, have caused numerous special sessions and cost the taxpayers millions of dollars of unnecessary expenses." The special session will cost more than $60,000 per day. "He's Senate president. I can't do a thing about that," Beshear said. "But what I can do is make sure that the people of this state know very loudly and clearly what damage he is causing to Kentucky."

Beshear even criticized Williams in his agenda for the special session, which included "legislation to enhance and expand tools and resources critical to Kentucky's continuing efforts to address the scourge of prescription drug abuse that plagues our citizens."

Negotiators on the prescription-drug measure, House Bill 4, came up with a compromise that pleased the Kentucky Medical Association, which opposes moving the state prescription-drug monitoring system to the attorney general's office from the Cabinet for Health and Family Services and the doctor-controlled Kentucky Board of Medical Licensure. The compromise would still make that move, and still limit ownership of pain clinics to physicians, but dropped a requirement that all physicians pay $50 to use the system.

Beshear railed against the impasse. "Sen. Williams willfully ignored the visible misery of our communities and allowed this essential bill to die," he said in a press release. "Why? Because of his road projects." Some lawmakers said another factor was House Democrats' refusal to override any of Beshear's budget vetoes, in spite of what Williams said was House Speaker Greg Stumbo's pledge to override. Stumbo denied making such a pledge.

On the road issue, "Williams wanted Beshear to sign the transportation projects list into law before the Senate voted on the bill authorizing the road construction money. Without the funding bill, those projects couldn't get started," reports Ryan Alessi of "Pure Politics" on cn|2, a cable-company news service. "Williams didn't want to give Beshear the ability to veto the project list and be able to unilaterally decide how to spend the $4 billion in federal and state road and bridge construction money."

According to Beshear, $288 million was allotted in the funding plan for Williams' district, $130 million of which would have been funded in the near future. But Williams "made some last-minute fine-print changes that moved an additional $155 million of those projects in his district ahead of those in other communities around the state." (Read more)

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Beshear vetoes parts of budget, but health spending is intact

Though Gov. Steve Beshear vetoed 45 parts of the state budget yesterday evening, health-related spending was safe from the cut.

The budget will help reduce caseloads for social workers who investigate child abuse and neglect, funds colon cancer screenings for 4,000 uninsured Kentuckians, substance-abuse treatment for Medicaid recipients and includes funding for an elder abuse registry to protect senior citizens from unscrupulous caretakers.

"This is the most difficult budget I have ever drafted, and it will also be a challenge to implement and manage over the next two years," the governor said in a statement.

In the two-year, $19 billion budget, Beshear voted more than three dozen line-item appropriations, including "portions of the General Fund budget that limited his ability to manage the state's budget or spent money that doesn't exist," reports Beth Musgrave of the Lexington Herald-Leader.

He also cut some earmarks, including $100,000 for Actors Theatre of Louisville and $150,000 for the International Mystery Writers' Festival in Owensboro. "I am vetoing these parts because they identify new spending earmarks yet the General Assembly failed to appropriate additional funds to finance them," Beshear said. (Read more)

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Beshear tells national audience legislature should pass pill-mill bill

Today, Gov. Steve Beshear again called on legislators to pass a bill Thursday that would crack down on so-called pill mills and thus curb prescription drug abuse. Speaking at the National Prescription Drug Abuse Summit in Orlando, Beshear asked for comprehensive collaboration to fight the problem, which kills more Americans than car accidents.

"No state or community is an island. It will take all of us — working across geographical and agency borders — to make headway against prescription drug abuse," he said.

The three-day summit is sponsored by Operation UNITE, which serves Kentucky's Fifth Congressional District, and features 100 leaders and experts, including Surgeon General Regina Benjamin, Office of National Drug Control Policy Director Gil Kerlikowske, Fifth District Rep. Hal Rogers, and Centers for Disease Control Principal Deputy Director Illeana Arias.

Beshear outlined what has already been implemented in Kentucky to combat the problem, including working with Ohio, Tennessee and West Virginia to identify those who exploit the system by crossing state borders and forming a panel of health professionals to develop criteria to identify suspicious drug-prescribing habits. But he also stressed the importance of passing House Bill 4, which would require pain clinics to be owned by doctors, require doctors to participate in the state's prescription-tracking system, and move the system to the attorney general's office from the Kentucky Board of Medical Licensure and the Cabinet for Health and Family Services.

The latter provision continues to draw opposition from the Kentucky Medical Association, which is lobbying hard to make changes to the bill, or perhaps kill it. Beshear has been touting the bill, considered the cornerstone of this year's General Assembly, since before it was filed. Al Cross, director of the University of Kentucky's Institute for Rural Journalism and Community Issues, said on KET's "Comment on Kentucky" Friday night that if the bill does not pass, the legislative session will be a failure. (Read more)

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Doctors' lobby still working for changes in 'pill mill' legislation

By Al Cross
Kentucky Health News

The Kentucky Medical Association, historically one of the most powerful lobbying interests at the General Assembly, has mounted a last-ditch attempt to change or perhaps kill the bill that would crack down on "pill mills" that contribute to prescription drug abuse.

The bill would require pain clinics to be owned by doctors, require doctors to participate in the state's prescription-tracking system, and move the system to the attorney general's office from the Kentucky Board of Medical Licensure, which is made up almost entirely of doctors and has done little to curb the growing problem.

The tracking system remains the central concern for the KMA, which issued a "call to action" for physicians to contact legislators and argue that it "could infringe on privacy and lead to excessive oversight of legitimate medical practices," reports Mike Wynn of The Courier-Journal. "Other critics have said the bill could make doctors reluctant to provide pain medication for legitimate patients."

KMA President Shawn Jones told Wynn, “We would like to see something come out of this session. We would just like to make sure that it is something that addresses both the needs of law enforcement and at the same time is not overreaching in its imposition on our ability to practice medicine in a professional way.”

The KMA’s call notes that the system "tracks medications such as Xanax, Valium and Klonopin and was placed under the cabinet’s responsibility partly for patient privacy and protection," Wynn notes. Jones told him, “The access to that data really should be limited to government agencies that are charged with public health, and not law enforcement.”

Moving the tracking system to the attorney general's office is "pretty much a cornerstone of this legislation," Senate Majority Floor Leader Robert Stivers, R-Manchester, left, told Ryan Alessi Friday night on cn|2's "Pure Politics" program. He said the medical licensure board "hasn't done a whole lot" about prescription drug abuse, and indicated that part of the bill would stand.

However, Stivers said he and other supporters of the bill might drop the bill's 30-day limit on the length of painkiller prescriptions because of concerns that it would raise costs to patients. Those concerns helped delay the bill on the 59th day of the legislature's 60-day session. House Speaker Greg Stumbo "has said the issue could be resolved with a simple fix in the bill’s language," Wynn notes.

Stivers and Stumbo were among a group of bipartisan political leaders, led by Gov. Steve Beshear, who issued a statement Friday calling on the General Assembly to pass the bill Thursday, when it is scheduled to reconvene. The legislature is in recess, pending possible vetoes of other legislation by Beshear.

KMA "also takes issue with a $50 fee that the attorney general would be able to charge doctors to fund the program," Wynn reports. "Jones said the amount will only continue to climb in coming years to address a societal problem that doctors did not create. Proponents contend that the fee is nominal and is capped by statute except for inflation adjustments." (Read more)

Kentucky Health News is a service of the Institute for Rural Journalism and Community Issues, based in the School of Journalism and Telecommunications at the University of Kentucky, with support from the Foundation for a HealthyKentucky.

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In bipartisan way, political leaders push passage of 'pill mill' bill

A bipartisan group of political leaders issued a call today "to pass a bill that will help the state battle one of its most significant threats – prescription drug abuse," a press release from Gov. Steve Beshear's office said. Beshear, Attorney General Jack Conway, House Speaker Greg Stumbo, Senate Republican Floor Leader Robert Stivers, Sen. Jimmy Higdon, R-Lebanon, and House Judiciary Committee Chairman John Tilley, D-Hopkinsville, said the legislature should pass House Bill 4 when it returns to Frankfort for its final day April 12.

"Since the beginning of 2012, more than 400 Kentuckians have been hospitalized because of prescription drug overdoses – a statistic that the leaders say underscores the crucial need to pass this bill in this legislative session," the release said. "Kentucky has the nation’s sixth-highest rate of prescription drug overdose deaths, at nearly 18 deaths per 100,000."

Conway said in the release, “I'm hopeful everyone, including the medical community, can get on board with House Bill 4 to ensure that we don't lose another generation in Kentucky to prescription drug abuse.” The bill would move the Kentucky All Schedule Prescription Electronic Reporting (KASPER) system to Conway's office from the Kentucky Board of Medical Licensure, which is controlled by doctors and has done little to rein in "pill mills" that churn out prescriptions for painkillers.

"Law enforcement members warn that Ohio, Tennessee, West Virginia and Florida have passed legislation similar to HB 4 to address pill mills, and failing to pass similar legislation could create a diversion effect in which Kentucky could become a source state for prescription painkillers," the release said.

Stumbo, who preceded Conway as attorney general, said in the release, “Given the true epidemic we are seeing, we cannot afford to wait another year to try to pass this again.” In October, Stumbo, Beshear and Conway "announced creation of an advisory board of physicians, dentists, nurses, and pharmacists to work with KASPER officials and law enforcement professionals to create guidelines for generally accepted prescribing practices among different medical disciplines," the release said. "These criteria will be used as a guide for when a prescriber or dispenser’s KASPER reports may be flagged for unusual prescribing activity."

The bill would require all prescription providers to register and use KASPER, require pain management clinics to be owned by a licensed medical practitioner, make medical licensure boards investigate prescribing complaints within four months. 

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This is Child Abuse Awareness Month; tips for prevention

April is child abuse awareness month, and the state Cabinet for Health and Family Services is reminding Kentuckians that it's the law to report suspected child abuse or neglect.

"Protecting our children should be everyone's number one priority, and during the month of April, we are raising awareness about the warning signs of child abuse and how to report it," Gov. Steve Beshear said. "The cabinet works year round to educate our families and investigate every aspect of abuse. Together, we can make Kentucky a safer place for all our children."

To report child abuse, Kentuckians should call 800-KYSAFE1. Calls are anonymous. If the report meets the criteria for abuse, an investigation is conducted within 24 hours in most cases or, if the child is suspected to be in immediate danger, they are conducted within the hour.

Callers should try to know the child's name, approximate age, address, parents' names and location of the child when the call is made. They should also have names and phone numbers of other people who have information about the suspected abuse.

The ultimate goal is to reunite families when circumstances improve. "We want children to return home to a stronger, safer family," said Jim Grace, assistant director of the Department for Community Based Services' Division of Protection and Permanency.

The cabinet's handling of child abuse investigations and its reluctance to release records pertaining to child abuse deaths and near deaths has been a hot-button issue in the past year. The Courier-Journal and Lexington Herald-Leader both sued the cabinet for refusing to turn over records and a judge twice ruled the cabinet was wrong not to do so. Since, it has released hundreds of pages of records, but has chosen to redact, or omit, some of the information therein. In January, Beshear acknowledged the cabinet had been accused of "operating under a veil of secrecy in a supposed attempt to protect inept workers and a poorly designed system."  Legislators have since heard hours of arguments about the issue, and a bill that would create an external panel to review child abuse cases involving fatalities and near-fatalities, while imposing more secrecy, is one of the few measures that could pass the General Assembly when it re-convenes for one day next Thursday to end its legislative session.

In its effort to increase awareness about child abuse, the cabinet offered strategies for parents to prevent abuse, including:

• never discipling a child when a parent's anger is out of control

• never leaving a child unattended, especially in a car

• learning the signs of physical abuse, nothing bruises, cuts, burns or other injuries a child can't explain

• teaching children the difference between "good touches," "bad touches" and "confusing touches"

• listening to a child when he or she doesn't want to go with something

• noting a change in a child's behavior or attitude

• teaching children what if he or she gets lost

• teaching children the correct name for private body parts

• being alert for talk that indicates premature sexual understanding

• paying attention when someone shows an unusual interest in a child

• making sure a child's school or daycare will only release him or her to a designated person
(Read more)

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Bill amendment could make dental, vision care more expensive

A last-minute amendment to a bill intended to limit when insurance companies could terminate policies may end up costing Kentuckians more out-of-pocket dental and vision expenses, Courier-Journal political writer Joseph Gerth writes in his weekly column.

The implications of House Bill 497 changed when Sen. Tom Buford, R-Nicholasville, "filed a one-paragraph amendment that was brought to him at the last minute by a lobbyist for the Kentucky Dental Association," Gerth writes. "That amendment said that if you have vision or vision insurance, your insurance provider can't require your health care provider to give you discounted rates on services that aren't paid for by the insurance plan."

That could mean that low-cost plans that only cover a few procedures but offer "added benefit by making sure you're not paying inflated prices for other services" may no longer be available, Gerth reports. Opponents say insurance companies will stop offering such plans because people won't buy them without the discounts. And people who can't afford more expensive plans will sacrifice dental and vision insurance.

On Tuesday, the Senate adopted the amendment and passed the bill. The bill cleared the House the next day. Gov. Steve Beshear has not indicated if he will sign or veto it.

Advocates say the bill will save in dental and vision care costs. Opponents say people will have difficulty having access to case. As for who's right, Gerth writes: "Bill advocates have presented no evidence to suggest that, and there have been no full-fledged hearings for the dentists behind the bill to make their case or to answer the questions that need to be asked." (Read more)

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Effort to boost oral health in nursing homes gets tangled up with industry's attempt to insulate itself from lawsuits; both bills die

A bill to get nursing-home residents better dental services "appears to be dead after the Senate added language from another bill designed to shield the nursing-home industry from litigation," Deborah Yetter reports for The Courier-Journal.

House Bill 510 would have created a pilot project for the state's two dental schools to create "a program to provide better oral-health services to nursing home residents," Yetter writes. "But on Wednesday, the Senate Health and Welfare Committee added language from another bill that had stalled in the House that would require people who want to file malpractice lawsuits against nursing homes to first submit the complaint to a 'medical review panel'." (Read more) 

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Legislature passes bill on personal-care homes but stalls on one to regulate pill mills as doctors lobby hard

By Al Cross
Kentucky Health News

The effort to quash "pill mills" that feed one of Kentucky's worst problems, prescription drug abuse, stalled on the next-to-last day of the General Assembly's session and faces cloudy prospects on April 12, when the legislature returns to conclude its business. But the legislature gave final passage to a bill aimed at limiting the admission of mental patients to personal-care homes.

The snag in the pill-mill bill stems from the Kentucky Medical Association's opposition to moving the state's electronic prescription-tracking system to the attorney general's office from the Kentucky Board of Medical Licensure, which is controlled by doctors and has been found to go easy on them, compared to other states. The bill includes several other measures, including a requirement that pain clinics must be owned by doctors.

After Sen. Carroll Gibson, R-Leitchfield, failed in a parliamentary maneuver to make the bill more difficult to pass, and Senate President Pro Tem Katie Stine, R-Southgate, ruled that his motion had lost on a voice vote, Majority Floor Leader Robert Stivers, R-Manchester, "said it might be better to consider the bill April 12, but Sen. Ray Jones, D-Pikeville, said delaying a vote on it would give its opponents more time to try to kill it," report John Cheves and Jack Brammer of the Lexington Herald-Leader. "Stivers called for party caucuses to meet to discuss the issue. After the caucus meetings, the Senate adjourned and Stivers said lawmakers would work on the bill for possible consideration April 12."

The session's final day is scheduled to give the legislature a chance to override any vetoes by Gov. Steve Beshear, so a bill passed then could be killed by a veto. That might seem unlikely, since Beshear has been among those pushing for stronger action against pill mills. However, if he were unhappy with a bill the legislature sent him, he could veto it and call a special legislative session to pass one more to his liking. That possibility, and his power to set the agenda of a special session, could make him a player in the negotiations between now and April 12.

The bill’s sponsor, House Speaker Greg Stumbo, D-Prestonsburg, downplayed the problem. He blamed it on "confusion over a provision that limits the amount of drugs that may be supplied to a patient at any one time," Mike Wynn of The Courier-Journal reports. "Some lawmakers feared that limits on prescriptions would cause more patient co-pays, but a simple fix to the bill’s language could allay those concerns, Stumbo said."

Also on Friday, the legislature sent Beshear a bill that would "require potential residents at personal-care homes to be screened for brain injuries by medical professionals," the Herald-Leader reports. "Personal care homes provide long-term care for people who do not need full-time nursing care but need some assistance."

Senate Bill 115 "stems from the death last year of Larry Lee, a brain-injured resident who disappeared from a personal care home and was found dead four weeks later on the banks of the Licking River, not far from the Falmouth Nursing Home in Pendleton County," the Herald-Leader notes. "There are about 2,500 to 3,000 people in 82 free-standing personal care homes across Kentucky," and many are mentally disabled or mentally ill. Kentucky Protection and Advocacy, a watchdog state agency, released a report last week saying that said placement of the mentally ill in personal-care homes violates federal disability laws. (Read more)

Kentucky Health News is a service of the Institute for Rural Journalism and Community Issues, based in the School of Journalism and Telecommunications at the University of Kentucky, with support from the Foundation for a Healthy Kentucky.

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'Meds for meth' bill is about to become law despite heavy lobbying campaign by pharmaceutical companies

The bill to limit purchases of a popular cold medicine used to make methamphetamine passed the General Assembly today and Gov. Steve Beshear said he would sign it.

The Senate voted 29-8 to approve changes the House made in Senate Bill 3, sponsored by Senate Majority Floor Leader Robert Stivers, R-Manchester, left. The bill would require a prescription to buy more than 7.2 grams of pseudoephedrine in a month and 24 grams in a year. "A generic box of pseudoephedrine with 48 pills, each with a 30-milligram dosage, contains 1.44 grams of the medicine," Jack Brammer of the Lexington Herald-Leader reports. ""Gel caps and liquid pseudoephedrine would be excluded from the limits in SB 3 because making meth from those forms is considered more difficult."

The bill’s sponsors had wanted lower limits, an initially a prescription for any amount, "but they compromised with opponents who worried about inconveniencing cold and allergy sufferers," Brammer notes. "The pharmaceutical industry has lobbied aggressively against the state requiring prescriptions for pseudoephedrine at any level," ranking first in reported lobbying expenses without even counting its extensive advertising campaign. The industry apparently viewed Kentucky as a sort of firewall, the absence of which could make passage of similar "meds for meth" bills in other states. Only Oregon and Mississippi now have such legislation.

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Makers of Sudafed, similar cold medicines again lead in legislative lobbying expenses, and that doesn't count their radio ad campaign

The Consumer Healthcare Products Association, which is fighting legislation that would limit the amount of pseudoephedrine that could be bought without a prescription, remained the leading spender among lobbying interests at the General Assembly in February, the state Legislative Ethics Commission said in its monthly newsletter.

CHPA, which represents manufacturers and distributors of over-the-counter medicines, spent $192,985 on lobbying in February, and a total of $388,000 for the first two months of the session. Those amounts do not include an extensive radio advertising campaign, which from all indications has cost more than the spending that had to be reported.

Other health-care interests were among the top spenders in February. Ranking second through 11th were the Kentucky Hospital Association ($38,422, for a two-month total of $74,543); the Kentucky Chamber of Commerce ($30,056, two-month total $63,404); Altria (Philip Morris) Client Services ($28,129, two-month $50,434); the Kentucky Farm Bureau Federation ($24,805, total $38,655); AT&T ($24,199, total $47,432); the Kentucky Medical Association ($21,958, total $42,731); the Kentucky Education Association ($21,629, total $45,249); the Kentucky Retail Federation ($21,191, total $45,452), which also opposes the meds-for-meth bill; Kentuckians for the Commonwealth ($18,317, total $34,188) and the Kentucky Optometric Association ($18,227, total unavailable).

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Meds-for-meth, pain-pill bills each clear a second chamber; both probably headed to conference committee(s)

"State lawmakers gave new life Wednesday to two bills designed to tackle Kentucky's problems with methamphetamine labs and prescription drug abuse," John Cheves and Jack Brammer report for the Lexington Herald-Leader.

"On a 60-36 vote, the House approved Senate Bill 3, which would further limit the amount of cold medicines containing pseudoephedrine that consumers could buy without a prescription. Pseudoephedrine is a key ingredient used in making meth. Meanwhile, the Senate approved House Bill 4, which transfers from the state Cabinet for Health and Family Services to the attorney general's office an electronic monitoring system that keeps track of prescriptions for pain pills. The vote was 26-9. Both bills are likely to go to conference committees made up of representatives from both chambers, who will try to negotiate a compromise on differences in the House and Senate versions of the bills." (Read more)

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House panel OKs "meds for meth" bill; chair predicts passage

The bill to limit purchases of the cold medicine used to make methamphetamine cleared another legislative hurdle Monday, and the chairman of the committee that approved it predicted that it will become law despite a heavy lobbying effort by over-the-counter drug makers.

By a 10-4 vote, the House Judiciary Committee approved a version of Senate Bill 3 that differs slightly from the version passed by the Senate. Rep. John Tilley, a Hopkinsville Democrat and the committee’s chairman, predicted the revised SB 3 will pass on the House floor. "Tilley said Senate leaders have signed off on the changes the House committee made," Jack Brammer reports for the Lexington Herald-Leader.The House version clarifies "language regarding prescriptions" and would ban "criminals convicted of meth-related offenses from purchasing pseudoephedrine for a five-year period," Mike Wynn of The Courier-Journal reports.

The core of the bill would allow consumers without meth records to buy 7.2 grams of medicines with pseudoephedrine each month, approximately a two-week dose, and up to 24 grams per year, without a prescription. Another 7.5 grams a month or 90 grams a year could be available with a prescription. "Experts have testified that those amounts are adequate for most cold and allergy sufferers, and more than 90 percent of all purchasers use dosages that fall below the proposed thresholds," Wynn reports. "State law already limits purchases to 9 grams per month, with a yearly cap of 108 grams, and purchasers are required to present a photo ID and sign a log at the point of sale."

The bill would not apply to gelcaps, which are more difficult to use for meth, or liquids, which are used for children. (Read more)

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Meds-for-meth bill stalls in state House committee

A measure aimed at curbing methamphetamine production failed to come to vote in the House Judiciary Committee Tuesday. Rep. John Tilley, a Hopkinsville Democrat who chairs the committee, said he hopes Senate Bill 3 will be voted on later this week.

The bill, which was passed by the Senate March 2, "would allow consumers to buy 7.2 grams per month of medications containing pseudoephedrine and up to 24 grams annually, an amount adequate for most cold or allergy sufferers, according to testimony," reports Deborah Yetter for The Courier-Journal. "A doctor's prescription would be required for an additional 7.5 grams per month or an additional 90 grams per year." The bill would exempt liquid or gel-cap formulations of the drug.

Right now, Kentuckians can buy 9 grams of the medicines per month and 120 grams per year.

Some committee members said they are concerned people could be breaking the law if they get or own too much of the drug. Rep. Joe Fischer, R-Fort Thomas, said his wife takes Claritin D, which contains pseudoephedrine, for allergies on a regular basis and asked if the bill would make it too hard for people like her to get the drugs without going to the doctor first. (Read more)

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Courier-Journal editorialists change position and join the Herald-Leader in supporting meds-for-meth legislation

The state's two biggest newspapers are in agreement: pseudoephedrine should be available by prescription only in order to curb methamphetamine production. The Courier-Journal offered its opinion in an editorial today: "Meth remains a scourge in Kentucky. It is not going to go away soon and without strong action its deadly, family-shattering impact will not diminish."

The position represents an about-face for the paper in Louisville, where the editorial board previously felt "such a restriction would create unnecessary burdens and expenses for legitimate users of pseudoephedrine."

However, with the meth problem not going away — there were a record 1,080 labs discovered in 2010 — the newspaper has changed its position, though acknowledged prescription-only will create some problems of its own: "'Pill mills' will likely dispense pseudoephedrine, just as they now illegally and unethically flood the market with pain medication, and police will have to crack down on such sales."

In December, the Lexington Herald-Leader offered its position, backing a prescription-only pills bill by Rep. Linda Belcher, D-Shepherdsville. "Methamphetamine would be a scourge if it hurt only those who ingested it. But the harm is far more widespread than that," it reads. "Highly mobile and as compact as a large soft-drink bottle, the meth-making process creates a risk of toxic exposure, respiratory injury and fire to all who come close."

The Courier-Journal backs Senate Bill 50, sponsored by Sen. Tom Jensen, R-London, and Sen. Robert Stivers, R-Manchester, which is similar to Belcher's bill. It narrowly cleared the Senate Judiciary Committee last week, but opposition to it "has hardened" in the Senate, the editorial reads. (Read more)

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Group fighting meds-for-meth bill says it spent nearly $200,000 in January on lobbying, and that apparently omits radio buys

The group fighting a bill that would make the key ingredient for making methamphetamine available only by prescription spent more than $194,000 last month alone to lobby lawmakers, far more than any other lobbying interest at the General Assembly.

The Consumer Healthcare Products Association "reported spending more on Frankfort lobbying for the month than the next eight largest groups combined," reports Tom Loftus of The Courier-Journal. "That's almost an obscene amount of money to be spending on one month on one issue," said Senate Majority Leader Robert Stivers, R-Manchester. Stivers is sponsoring the bill, which would require a prescription for cold and allergy medicine that contains pseudoephedrine.

The group with the second highest spending was the Kentucky Hospital Association, at $36,120.

CHPA "is a group of manufacturers and distributors of over-the-counter medicines whose members include Bayer Healthcare, GlaxoSmithKline and Johnson & Johnson," Loftus reports. In a statement Monday, the group said it is again "efforts by some legislators to deny law-abiding citizens nonprescription access to certain cold and allergy medicines they depend on."

The $194,957.76 spent on lobbying apparently does not include what the CHPA spent on broadcast advertising, which it does not have to report. As of Feb. 3, the group had spent more than $82,000 running ads on Louisville, Lexington and Somerset radio stations owned by Clear Channel Communications Inc., the nation's largest radio operator, according to public-inspection files at those stations, the only ones that have been checked by Kentucky Health News and its journalistic partner, Jonah Engle. In 2011, CHPA paid the Kentucky Association of Radio and Television more than $93,000 to run ads, according to public-inspection files from Cumulus Broadcasting, another major owner of stations in Kentucky.

As for lobbying expenses, more than $12,000 was spent on salaries for three lobbyists, plus nearly $4,000 for food, lodging, beverage and transportation expenses. More than $150,000 was spent "for professional and technical research and assistance," plus nearly $27,000 for "educational and promotional items."

"I'm not surprised they reported so much for lobbying because it's obvious they're doing a pretty good job of getting their message out ... which I believe is a misleading scare campaign," said Sen. Ray Jones, D-Pikeville, who is co-sponsoring the meds-for-meth bill. (Read more)

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Senate committee narrowly passes meds-for-meth bill as advocates start their own radio advertising campaign

In the face of a strong lobbying effort by makers of over-the-counter cold medicines, a state Senate committee narrowly approved a bill today that would require a prescription for most products containing pseudoephedrine, a key ingredient used to make methamphetamine.

Senate Bill 50, approved 6-5 by the Judiciary Committee, is sponsored by Senate Majority Floor Leader Robert Stivers, R-Manchester, left, but he said he isn't sure of its chances in the full Senate, reports Jack Brammer of the Lexington Herald-Leader. A similar bill got out of committee last year but never came to a vote on the Senate floor because it lacked the votes to pass. This year's bill would not apply to gelcaps, which are more difficult to use in meth making.

The Kentucky State Police recorded about 1,200 meth labs last year, and former meth addict Melanda Adams, from Stivers' home Clay County, told the committee she believed the bill would "cut the burgeoning number of dangerous home-made meth labs in the state." The Consumer Healthcare Products Association, a non-profit that represents the over-the-counter medicine industry, argues that requiring a prescription would "create a hardship for legitimate consumers," reports Jessie Halladay of The Courier-Journal.

Only Oregon and Mississippi have passed such laws, so Kentucky has become a firewall for the drug makers' lobby, which has bought many radio commercials urging people to contact senators in opposition to the bill, contending it would "punish Kentucky families" and pushing an alternative measure that would bar people convicted of meth making from buying the medicines. Opponents of that bill say meth makers would continue to use surrogates to buy the medicines for them. Sen. Ray Jones, D-Pikeville, who voted for SB 50, called the radio ads "scare tactics." UPDATE: For more on the lawmakers' complaints about the ads, from cn|2 Politics, click here.

As of Feb. 3, the group had spent more than $82,000 running ads on Louisville, Lexington and Somerset radio stations owned by Clear Channel Communications Inc., the nation's largest radio operator, according to public-inspection files at those stations. In 2011, CHPA paid the Kentucky Association of Radio and Television more than $93,000 to run ads, according to public-inspection files from Cummulus Broadcasting, another major owner of stations in Kentucky.

UPDATE, Feb. 17: The drug makers have a 60-second ad from Pat Davis, who identifies herself as "a Kentucky resident for over 20 years" and the mother of six children who all "battle allergies." She is not identified as the wife of 4th District U.S. Rep. Geoff Davis, who is not seeking re-election. She testified against last year's bill. Here is the ad, via Page One Kentucky, a popular blog that has been critical of the legislation.

The drug makers' ads have been running uncontested for two months, but this week a group headed by Knox and Laurel County's Commonwealth's Attorney Jackie Steele, Real Facts About Meth, offered a counter-ad, describing the impact of meth on communities. The group does not appear to be well funded; its website solicits contributions.

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Legislators hear from new managed-care firms; lawmaker rates their performance with a show of hands from pharmacists

Kentucky Health News

The three companies recently hired to manage Kentucky's Medicaid program outside the Louisville region defended themselves yesterday against complaints that they are squeezing independent pharmacies to the breaking point. One of the three firms, Kentucky Spirit, fared better in a hearing held by a House-Senate committee before a crowd that included many pharmacists.

When Sen. Vernie McGaha, R-Russell Springs, "asked for a show of hands from pharmacists in the audience to learn which of the three pharmacy-benefits companies they think underpay on generic drugs, nearly everyone raised their hands for Medco Health Solutions, which is Coventry [Cares]'s partner, and Catalyst Rx, which is WellCare [of Kentucky]'s. No one seemed to object to US Script, which is Kentucky Spirit's partner," reports John Cheves of the Lexington Herald-Leader.

Kentucky Spirit is the only firm that continues to pay pharmacists a dispensing fee of $4.50 to $5 per prescription, the rate that had been paid by the state. WellCare pays $3, and CoventryCares $1 to $1.50, the pharmacists told Deborah Yetter of The Courier-Journal. "Pharmacists have told lawmakers at previous hearings that pharmacy-benefits companies sometimes pay less for generic drugs than it costs pharmacies to acquire them," Cheves notes.

Read more here: http://www.kentucky.com/2012/02/13/2067444/medicaid-managed-care-companies.html#storylink=cpy

Rep. John Will Stacy, D-West Liberty, left, whose business interests include co-ownership of at least two pharmacies, got into it with G. William Strein, Medco's vice president for provider relations. "Stacy cut off Strein several times while he was attempting to answer," Cheves reports.

“Why is it fair that you can reimburse us below costs?” Stacy asked Strein, who "disputed Stacy’s assertion and said managed care attempts to strike a balance between its estimated cost of the drug and the costs of the pharmacy to buy and dispense it," Yetter reports. "But that claim was disputed by some of the roughly 30 pharmacists at the hearing who operate independent drugstores. Though the hearing ended before they got a chance to testify, several said afterward that they intended to keep making their case before lawmakers."

Jason Wallace, owner of Grant County Drugs, told Yetter, “It’s a real burden for Kentucky pharmacists. That’s why I’m here.” All the companies told members of the Joint Program Review and Investigations Subcommittee that they are committed to resolving the problems.

"Much of Monday’s testimony was devoted to the complex pricing formula known as the maximum allowable cost, or MAC, that managed care companies consider proprietary," Yetter writes. "Under the Medicaid plan before managed care, the formula was provided to pharmacists, who said they knew what they would be paid. Now, they said, they don’t find out what a company will pay for a specific drug until they file claims.And too often, they say, it’s less than they paid to buy the drug.

“How would you like to go to a gas station and fill your car up with gas and then be told what the charge is?” Breckinridge County pharmacist Jonathan Van Lahr asked after the hearing. (Read more)

Kentucky Health News is a service of the Institute for Rural Journalism and Community Issues, based in the School of Journalism and Telecommunications at the University of Kentucky, with support from the Foundation for a Healthy Kentucky.

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