Kentuckians would pay more and get worse eye care if HB 191 becomes law

When Kentuckians went to the polls to elect their legislature, it surely was not their intention to elect representatives who would stifle emerging, money saving technologies designed to improve health outcomes. Yet, that is just what the body in Frankfort is gearing up to do. Legislators are barreling forward with a piece of legislation — House Bill 191 — that would restrict the ability of Kentuckians to renew contact lens and glasses prescriptions over the internet via a licensed doctor.

The bill is little more than a sop to incumbent interests determined to protect their business models from change. HB 191, which the House approved 90-7 and now awaits action in the Senate, would require Kentuckians to drive to visit optometrists and to pay for expensive exams each time they need to get their prescription renewed, instead of allowing them to get it renewed from the privacy of their home 24-7. Predictably, in doing so, the bill’s advocates claim their aim is to protect consumers. But, protecting consumers means promoting innovation, and that’s something HB 191 doesn’t do.

Let’s separate fact from fiction here.

Facts: There is simply no need for the frequency of office visits contact lens and eyeglass patients are undergoing today. The Academy of Ophthalmologists only recommends a comprehensive eye exam for people under 40 every five to 10 years, and every four years or less for those older. For the legions of Kentuckians simply seeking to renew their prescriptions on an annual basis, there is no medical reason to justify an in-person, as opposed to online, process for doing so.

What’s more, the process of online renewal isn’t simply a rubber-stamp. When submitted online, prescription renewals are reviewed and screened by state-licensed optometrists and ophthalmologists. Consumers continue to receive a high level of care, just at a reduced price, by completing their renewals online.

And of course, online renewals will not replace in-person eye exams. The process is not designed to. Rather, the goal of online-renewal is to reduce cost of vision-care based on the recognition that, as the Academy of Ophthalmologists points out, prescriptions tend not to rapidly change. Thus, as a statistical matter, in the vast majority of cases, there is no need for an expensive check-up.

The significant savings associated with limiting in-person exams can also serve to improve health outcomes. Today, patients who are not well positioned to afford such exams often continue to use vision aids beyond the manufacturer’s suggested wear schedule. In doing so, they raise their risk of eye infections and actually damage their vision. A less expensive online renewal option will not only make vision-care affordable for many in need, but will improve the outcomes for those already using vision aids.

And here is another fact: The wisdom of allowing prescription renewals has been recognized throughout the rest of the country. Thirty-eight states currently permit what Kentucky’s legislature is seeking to ban. There is more than a little amount of irony in the fact that Kentucky Gov. Matt Bevin’s recent push to eliminate needless occupational licenses and to otherwise free-up commerce would be ongoing at the same time as the push for HB 191.

If the state really is committed to presenting itself as an incubator for innovation and technology, falling-back into a protectionist posture in the medical field is the last step it should be taking. Ultimately, when it comes to vision care, consumer choice and convenience are not at odds with innovation and the best medical science. It’s long overdue the legislature recognize this and ditch HB 191.


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