Using his pardon power, Beshear lets people with certain certified health conditions possess up to 8 ounces of medical marijuana

Beshear displayed a map showing in green the adjoining states where medical cannabis is legal.

By Al Cross
Kentucky Health News

Kentuckians who meet a detailed set of requirements would be able to possess up to 8 ounces of marijuana for medical use starting Jan. 1, under an executive order Gov. Andy Beshear signed Tuesday.

The drug would have to be bought in a state where the sale of cannabis is legal, and the person would need the receipt and a certification from a health-care provider saying that they have at least one of 21 specific conditions, including cancer, epilepsy, Parkinson's disease, Crohn's disease, sickle-cell anemia, severe and chronic pain, post-traumatic stress disorder, fibromyalgia, glaucoma or a terminal illness.

Beshear's order is in the form of an advance, conditional pardon. He had not mentioned such a device in his seven months of public deliberation about the issue, which began when the state Senate again refused to hear a House-passed bill to legalize medical cannabis. Republicans control both chambers.

The highest-quality health care is a human right," the Democratic governor asserted. Noting that Kentucky has high rates of cancer and painkiller overdoses, he said "There's another way to manage the pain without the threat of addiction."

Beshear created a Medical Cannabis Advisory Committee that held several public hearings on the issue. It received more than 3,500 comments, 98.6% of which favored of legalizing medical cannabis, he said.

"Kentuckians are leaving this state to access medical cannabis," he said. "Some of them are leaving this state for good." The drug is legal in 37 states.

One commission member, Justice Secretary Kerry Harvey, said cannabis is "a treatment that's already available to the overwhelming majority of Americans but not Kentuckians," some of whom have declined to use the drug because they don't want to violate the law: "What an awful choice that must be."

Jared Bonvell, a veteran from Northern Kentucky, said his use of cannabis gave him "a change of life that is just absolutely astounding," allowing him to stop taking 13 medications.

Paducah contractor Craig Manley said in a video that nothing took away his pain except THC, the psychoactive ingredient in cannabis.

State and federal law define marijuana as containing Delta-9 THC. Products containing Delta-8 THC, a less potent form, are on the market legally. Beshear signed another order regulating Delta-8 THC and said it would provide the legal framework for regulating cannabis if the legislature legalizes it.

Beshear's cannabis order notes that 8 ounces is the most marijuana that can be possessed under Kentucky law without being a felony, and says the health-care provider's certification "shall not constitute a prescription for medical cannabis."

The order allows the cannabis to be possessed by a caregiver, defined as someone at least 21 and with "significant responsibility for managing the well-being of the individual on whose behalf the cannabis was purchased."

"Today's actions are not substitutes for much-needed legislation," Beshear said. "What we're trying to do is take a measured step to help those who are struggling."

John Cheves of the Lexington Herald-Leader reports, "There may yet be legal challenges to Beshear’s actions. House and Senate leaders did not immediately respond to requests for comment Tuesday. But the office of Republican Attorney General Daniel Cameron, who often clashes with Beshear, said he’s studying the orders."

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$35 cap on seniors' monthly insulin costs isn't reflected in online 'plan finder' that is used by Medicare members to choose a plan

Screenshot of Medicare plan finder; for the web page, click here.

By Susan Jaffe
Kaiser Health News

A big cut in prescription drug prices for some Medicare beneficiaries kicks in next year, but finding those savings isn’t easy.

Congress approved in August a $35 cap on what seniors will pay for insulin as part of the Inflation Reduction Act, along with free vaccines and other Medicare improvements. But the change came too late to add to the Medicare plan finder, the online tool that helps beneficiaries sort through dozens of drug and medical plans for the best bargain.

Officials say the problem affects only 2023 plans.

To fix anticipated enrollment mistakes, Medicare officials will give beneficiaries who use insulin a chance to switch plans next year. They can make one change after Dec. 8 and throughout 2023 through a special enrollment period for “exceptional circumstances.” Typically, people are locked in for an entire year.

The Centers for Medicare & Medicaid Services provided initial details of the opportunity in a document distributed to the State Health Insurance Assistance Program, or SHIP, which assists Medicare enrollees in every state. Although Medicare did not publicize the document, beneficiaries can get more information by contacting their local SHIP office. CMS officials would not answer questions about whether the ability to change plans will be granted automatically.

In some cases, a special enrollment period can be avoided, said Janet Stellmon, director of the Montana State Health Insurance Assistance Program. If the plan charges more than a $35 copayment for a member’s insulin, a SHIP counselor can ask the plan to correct the mistake. “Plans usually try to make it right quickly,” said Stellmon, who helped one beneficiary save $565 a month on insulin.

Medicare patients spent $1 billion in 2020 on insulin products — four times the amount in 2007, with some paying as much as $116 a month out-of-pocket, KFF has found. Americans paid an average of five to 10 times as much for insulin in 2018 than in other countries, according to a recent study. About 3.3 million people with Medicare rely on one or more insulin products to control blood sugar levels.

The $35 copay for injectable insulin products takes effect Jan. 1, and July 1 for patients who use an insulin pump.

When beneficiaries who use insulin now check the plan finder, the price could show up as thousands of dollars a year instead of the maximum $420 stipulated by law. An inaccurate price could also distort the costs of other drugs, which depend on what coverage phase patients reach. For example, once both the plan and the patient spend a total of $4,660 for all drugs next year, the member pays no more than 25% of the cost for non-insulin drugs.

It’s extremely difficult for consumers to evaluate policy options without the plan finder. One plan might have the lowest price for one drug but not another. Or a plan might have the lowest premium but higher drug prices. Or a preferred pharmacy in one plan may be excluded in another.

The finder does display a warning: “This new $35 cap may not be reflected when you compare plans. You should talk to someone for help comparing plans.” It points readers to the Medicare help line — 800-633-4227 — or a counselor with SHIP.

It doesn’t mention the option of changing plans after the Dec. 7 enrollment deadline, but both SHIP counselors and representatives answering the Medicare help line rely on the same flawed plan finder.

Drug plans do not have to cover all injectable insulins, said Tatiana Fassieux, an education and training specialist at California Health Advocates. “It’s all about the formulary,” she added, referring to the list of drugs covered by a plan.

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Time for pharmacy-benefit managers to 'share the savings' in prescription-drug costs, crusaders against diabetes write

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Flu off to fast start; cases keep more than doubling each week in Kentucky; flu, Covid-19 and RSV threaten a 'triple-demic'

State Dept. for Public Health map, adapted by Ky. Health News; county figures are online here.

Last week's cases will
be reported on Friday.

By Al Cross
Kentucky Health News

Influenza is spreading quickly in Kentucky, raising the threat of a "triple-demic" of flu, Covid-19 and respiratory syncytial virus (RSV).

The state Department for Public Health's most recent report says 2,082 flu cases were confirmed during the week that ended Nov. 5. That was 140 percent more the the previous week, and case numbers the week before were more than triple the previous week. All told, 3,342 cases have been confirmed, and that does not include at-home tests.

Most of the cases have been in Kentuckians 20 and younger. Flu and other respiratory viruses have been so widespread that many school districts have closed schools or moved to nontraditional instruction for a few days.

Kentucky Department for Public Health graphs

Last Monday, 25 of the 171 public districts did; the following day was Election Day, when most were scheduled to be closed anyway for voting.

"More than 100,000 Kentucky students have been sent home this month, and health professionals are warning more closures are likely, saying there is a strong possibility of a "tripledemic" this winter," reports Krista Johnson of the Louisville Courier Journal. "For the past two years, safety measures related to Covid-19 have kept influenza and RSV case numbers low, but hospitalizations due to these viruses are increasing."

The state has confirmed one death from the flu, in an adult.

The flu is getting off to a faster start than usual. The percentage of clinic visits resulting in reports of influenza-like illnesses is higher than it has been in any of the last four years, according to a health department graph.

Dept. for Public Health graph; MMWR is the CDC's Morbidity and Mortality Weekly Report 

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Had trouble with a health-insurance claim? An appeal? National, nonprofit newsroom ProPublica wants you to help its reporting

Photo illustration from ProPublica

ProPublica, the national, nonprofit, investigative newsroom, wants Americans to help it report why health insurance claims are denied, what the consequences are for patients, and how the appeal process works. It says it has heard from hundreds of people about the obstacles they have faced when denied health care.

"Take Alyssa Miller, a hospital-based nurse," ProPublica reports. "When she was 16, she was diagnosed with cancer and had to undergo radiation treatment. Given her now-increased cancer risk, her oncologist said she’d have to get a mammogram by 25. But when she went to get the procedure, Miller’s insurer denied her claim because, per its policy, it only covers mammograms when patients are 40 or older. She fought back with an appeal backed by a note from her doctor. That was denied, too."

Miller told ProPublica, “I was just really frustrated and confused by the whole appeals process. I feel like I’m supposed to know how this works being a health care provider. I almost gave up.”

Miller was able to get her mammogram covered by asking her employer’s human-resources office to get involved, ProPublica reports, "but she is among just a small percentage of people who appeal these denials. . . . Even insurance company employees, doctors and nurses have to battle insurers for coverage for themselves and their family members."

ProPublica said it has heard from "more than 100 people who work in health care or insurance and have had difficulty getting care covered, including:

• A doctor whose son has a speech disorder but had to stop speech therapy because insurance would not cover it.
• A nurse practitioner with long COVID whose treatments are being denied by insurance.
• An ophthalmologist whose uncle had a detached retina, which can cause blindness without treatment. The insurer denied the surgery because it concluded the procedure was not emergent.

Now we are hoping to hear from more people who can help us understand what is happening on the inside as these decisions are made. If you or someone you know works in health insurance, please fill out this form." If not, use the link in the first paragraph of this story.

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Nov. 17 is American Cancer Society's Great American Smokeout

CDC graphic

By Melissa Patrick

Kentucky Health News

The American Cancer Society's annual Great American Smokeout, a day when smokers are encouraged to quit for the day and make a plan to quit for good, will be observed Thursday, Nov. 17. 

"The Great American Smokeout is more than a reminder of the dangers smoking poses to your health," says the Centers for Disease Control and Prevention. "It’s a call to act. No matter your age, or how long you’ve been smoking, quitting improves health both immediately and over the long term." 

Cigarette smoking continues to be the leading cause of preventable death in the United States and Kentucky, killing 8,900 Kentuckians a year. Nationwide, it kills more than 480,000 people, which is nearly one in every five deaths, says the CDC. 

Kentucky's smoking rates have steadily decreased for years, but the bad news is that nearly one in five Kentucky adults, or 19.6%, still smoke; 41% of Kentucky smokers said they had tried to quit in the last year, according to the 2021 Behavioral Risk Factor Surveillance System survey, a national CDC poll. 

The CDC says quitting smoking is one of the most important actions people can take to improve their health and offers a detailed list of the health benefits, including longer life, lowers risk of 12 types of cancer, lowers risk of heart and lung disease, and lower risk of poor pregnancy outcomes.  

Kentucky smokers have a number of tools to help them quit. The state runs a 1-800-QUIT-NOW hotline that offers free tobacco-cessation services. 

"The coaches at Quit Now Kentucky can help you make a plan to quit, manage nicotine cravings and get back on track if you have setbacks. Some people even are eligible for free nicotine-replacement therapy like nicotine patches, gum or lozenges," according to the state Cabinet for Health and Family Services webpage. 

And while Quit Now Kentucky provides free services to people of all ages, middle- and high-school students may want to try "My Life, My Quit," a free, confidential quitline for Kentuckians 17 and younger to help them stop smoking or vaping. Teens can text "Start My Quit" to 36072, or click on the live chat button on the My Life, My Quit website to chat with a coach.    

A 2017 law requires insurers, including Medicaid, to cover all seven tobacco-cessation medications approved by the U.S. Food and Drug Administration, and counseling services recommended by the U.S. Preventive Services Task Force. It also eliminated co-payments for medication and counseling, requirements tying medication coverage to counseling, and limits on length of treatment.

The American Cancer Society also offers a list of resources to help you quit using tobacco products.

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Map estimates how ready your county is to help with recovery

Screenshot, adapted by Ky. Health News; for the interactive version, click here.

By Liz Carey
The Daily Yonder

When officials in Vine Grove put out a vending machine filled with free opioid-overdose reversal medication, they expected people in the 7,000-person strong community would use it.

They just didn’t anticipate it being empty three days later.

“We put one machine out 27 days ago,” said Keith Mattingly, police chief of Vine Grove, located near Fort Knox about 25 miles southwest of Louisville. “Since then, we’ve gone through 169 boxes of Narcan.”

Narcan is a nasal spray version of Naloxone that reverses the effects of an opioid overdose. Giving it to an overdose victim can revive them within minutes.

In 2021, 2,250 Kentucky residents died of drug overdoses, a 14.5% increase over the previous year, the state’s Office of Drug Control Policy said. That includes 46 deaths in Hardin County, which includes Vine Grove. The increasing number of deaths in his community spurred Mattingly to do something.

“I’m just out to save some people’s lives,” Mattingly told the Daily Yonder.

The Narcan vending machine is one example of how rural areas are addressing the drug use epidemic. A new national index from the Center for Rural Health Research at East Tennessee State University called the Recovery Ecosystem Index Mapping Tool drills down to the county level to assess drug recovery systems across the country.

Each county has a composite of the information that goes into its index score. That includes information on substance-use-disorder treatment options, care that recovering people receive after initial treatment, and social indicators such as broadband access, number of vehicles available, and other factors.

The mapping tool, created in association with the National Opinion Research Center at the University of Chicago and the Fletcher Group, a consultancy, shows the recovery resources available in every county in the United States. The index then rates each county by comparing resources and demographic information against the county’s overdose mortality rates.

“The index is intended to serve local stakeholders to help them better understand the availability of recovery-related resources in their county and neighboring counties,” Andrew Howard of the Fletcher Group said in an email interview.

Researchers hope the index can also be used to develop best practices for use in other communities, as well as be used by policymakers to better understand how services are distributed, and how they can target counties that lack resources.

“We are hoping that people at the community level will use this tool to first determine the recovery ecosystem score for their community, but then to dig into the data to really understand where they can invest to create a better support system for their people,” said Michael Meit, co-director of the Center for Rural Health Research and one of the researchers on the project.

Meit said they found certain rural areas had greater success building out that recovery infrastructure. Although rural areas face more obstacles, he said, some are providing a better support system for their residents.

“To some extent, we expect to see lower scores in rural areas,” he said. “At the same time, there are places that do very, very well – in particular, Eastern Kentucky.”

There, the recovery ecosystem included access to harm-reduction programs, a network of support programs, and engagement with the criminal justice system and other groups to support recovery, he said.

“Rural areas, I think, have more structural challenges, but (building a recovery ecosystem) is still eminently achievable in rural areas,” he said.

Former Kentucky governor Dr. Ernie Fletcher, founder and chief medical officer for the Fletcher Group, said the recovery index would help communities across the country access detailed information on how to work more effectively and more efficiently.

“This will be a game-changer for recovery allies all across the country,” Fletcher said in a statement. “That’s especially important because recovery ecosystems involve so many moving parts and rely so heavily on local resources. Having a quick, accurate, and detailed snapshot of what’s available—and what’s missing—will be a godsend, especially in the rural communities we serve.”

While the index was released in September, and missed the addition of Hardin County’s vending machine, Meit said researchers anticipate updating the index regularly.

In Hardin County, officials are getting a first-hand look at what a successful overdose reduction program looks like. Who is taking the vending-machine Narcan? Mattingly said it varies.

“I’ve talked to elderly people who have addicted grandchildren,” Mattingly said. “They want to have it in case their grandchild overdoses at their house. We’ve had electrical contractors who’ve gotten them in case they come across someone overdosing when they go to a house. Are addicts coming to get them? There’s no way for us to know for sure, but I would assume so.”

So far, it looks like overdoses are down in the community, but he wasn’t going to draw conclusions until he had more data to compare it to, he said.

For now, though, he’s waiting until he can document one of his specially marked Narcan doses was used to reverse an overdose. Then, he said, he’ll know he’s done what he set out to do – save a life.

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