Lawmakers consider controversial changes to reduce KanCare drug costs

Committee OKs draft recommendations that include proposal to withhold hepatitis C treatment from ‘noncompliant’ patients

by Jim McLean, KHI News Service

A legislative oversight committee has approved a controversial set of draft recommendations aimed at reducing the cost of drugs provided to Kansas Medicaid recipients.

The joint committee that oversees the state’s privatized Medicaid program known as KanCare this week tentatively approved recommendations that direct the Kansas Department of Health and Environment to develop policies aimed at slowing a steady increase in the $3 billion program’s pharmacy costs.

The most controversial of the recommendations calls for withholding expensive hepatitis C drugs from KanCare recipients who don’t follow treatment requirements, such as patients who fail to take all their pills or consume nonprescription drugs or alcohol during treatment.

Sen. Jim Denning, an Overland Park Republican, said Kansas taxpayers shouldn’t have to pay for repeated treatments when patients knowingly engage in behaviors that undermine the effectiveness of their medications.

“I know it is pretty strong language,” Denning said. “But if we have patients that are abusing an $80,000 drug, then there have to be consequences.”

Hepatitis C is a liver infection caused by a virus spread through the exchange of blood or other bodily fluids.

The wholesale cost of a standard 12-week treatment for hepatitis C can range from $84,000 to $94,000 depending on the drug. Through the first four months of the fiscal year, KanCare has spent approximately $3.1 million on hepatitis C treatments, according KDHE documents.

Democrats on the committee objected to Denning’s proposal, saying it would be tantamount to imposing death sentences on noncompliant patients.

“It just seems like we’re making life and death decisions, and I’m just very uncomfortable with that,” said Sen. Laura Kelly of Topeka, the ranking Democrat on the committee.

Republicans who control the committee disagreed, saying the state has a responsibility to both KanCare recipients and taxpayers.

“We’re not sentencing people to death,” said Sen. Mary Pilcher-Cook, a Shawnee Republican and chairwoman of the oversight committee. “If a patient is noncompliant, they are making a decision.”

Members voted 5-2 to include the proposal in a set of draft recommendations that the committee is expected to complete at the start of the 2016 legislative session in January.

Panel members also endorsed a proposal to allow the three private insurance companies that manage KanCare to implement step therapy protocols. If lawmakers approve the change, the insurers could restrict providers’ ability to prescribe expensive drugs to patients in the general KanCare population unless cheaper alternatives had been tried and proven ineffective.

The committee also asked KDHE officials to compile a report on the extent to which certain behavioral health drugs are being overprescribed. Legislators are concerned about reports that powerful antipsychotic drugs are being inappropriately prescribed to children and used for the “off label” purpose of controlling the behavior of dementia patients in nursing homes.

A law passed earlier this year allows the state and the KanCare companies to establish a preferred drug list for mental health drugs. State officials are working with a stakeholder advisory committee to implement the change.

The nonprofit KHI News Service is an editorially independent initiative of the Kansas Health Institute and a partner in the Heartland Health Monitor reporting collaboration. All stories and photos may be republished at no cost with proper attribution and a link back to when a story is reposted online.

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Kansas appeals court sides with casino in tax case

Boot Hill Casino in Dodge City, Kan., does not have to pay a compensating use tax on lottery facility games, according to a decision by the Kansas Court of Appeals today.

Three casinos in Kansas, including Boot Hill, Kansas Star in Mulvane, Kan., and the Hollywood Casino at Kansas Speedway in Kansas City, Kan., are state-owned and operated. They have different private facility managers.

“A compensating use tax may not be imposed on a lottery gaming facility manager because the State of Kansas is the ultimate consumer of the electronic gaming machines and the lottery gaming facility manager has no incident of ownership in the electronic gaming machines,” the court of appeals ruled today.

The Kansas Department of Revenue had appealed the ruling from the Kansas Board of Tax Appeals.

Boot Hill Casino and Resort argued that since it was only the manager, where it uses and operates the electronic gaming machines owned by the Kansas Lottery and state of Kansas, that it should not have to pay the compensating use tax on the machines. Since there was no ownership of the gaming machines by Boot Hill, BOTA agreed that the compensating use tax did not apply, and the court of appeals affirmed the decision today.

According to court documents, the Boot Hill management company paid a use tax of $801,588.05 when it bought the electronic gaming machines for the Kansas Lottery from five out-of-state vendors.

Boot Hill paid the tax under protest and applied to KDOR for a refund, which was denied.

“The Kansas Lottery is the ultimate consumer, not BHCMC,” (Boot Hill), the appeals court opinion stated today. “BHCMC is not subject to the compensating use tax.”

The decision today did not discuss any details, such as how funds would be refunded to the Boot Hill casino.

To view today’s court decision, visit

New Year’s Eve alcohol consumption can be particularly dangerous, doctor warns

New Year’s Eve parties are going on around the world, but a physician at The University of Kansas Hospital in Kansas City, Kan., is warning people drinking alcohol on these occasions can have more of an effect than usual.

Dr. Michael Salacz, neurosurgeon at The University of Kansas Hospital, warns that any alcohol will lead to some impairment during the evening, but combining it with the fatigue of staying up past midnight can significantly multiply its effect.

Dr. Salacz said under no circumstances should anybody drink and drive. If someone wants to reduce the effect of alcohol, drink glasses of water in between alcoholic drinks. However, Dr. Salacz said, that reduces but not eliminates the effect of alcohol.

If you wake up tomorrow feeling you overdid it, then the doctor prescribes the same remedy: drink plenty of water to re-hydrate your body.