Any Willing Provider Legislation

Legislative and Regulatory Position: 

The Academy of Managed Care Pharmacy (AMCP) opposes any willing provider/pharmacy legislation. AMCP supports the ability of managed care organizations (MCOs) to selectively contract with only those providers necessary to enable the organizations to provide plan participants with adequate access to high-quality, cost-effective health care and pharmacy services. Managed health care systems maintain networks of providers who demonstrate they can deliver high‐quality, affordable health services to plan participants. By selectively contracting with providers, MCOs assure that plan participants can receive the best care, have appropriate access to the providers they need, and reduce the likelihood that valuable health care resources will be wasted through inappropriate use. 

Competition 

Any willing provider legislation requires MCOs to contract with any provider who agrees to meet the terms and conditions of the contract, regardless of whether the provider meets the quality and geographic access needs of the MCO. Proponents argue that these mandates assure that plan participants can choose among multiple providers for receiving their health services regardless of the quality of the provider. 

AMCP believes that plan participants are able to exercise this freedom of choice without any willing provider mandates. Health plans must compete against each other for plan participants--through employer‐sponsored programs, the individual market, or exchanges—and this competition motivates MCOs to provide access to a broad number of providers. Managed care plans are best situated to understand the unique needs of their population and go to great lengths to assure their networks have enough qualified providers to provide adequate access to medical services to the plan participants’. During enrollment, prospective plan participants can verify their provider participates in the plan through online resources. If a plan participant has not developed a provider relationship, they can choose from among the broad array of individual providers within the plan’s network. 

A 2022 study¹ identified that there were 61,715 pharmacies, including 37,954 (61.5%) chains, 23,521 (38.1%) regional franchises or independently owned pharmacies, and 240 (0.4%) government pharmacies. Across the overall U.S. population, 48.1% lived within 1 mile of any pharmacy, 73.1% within 2 miles, 88.9% within 5 miles, and 96.5% within 10 miles. MCOs are in the best position to address deficiencies based on their local market and plans. This includes addressing the evolving retail pharmacy access dynamic, such as access to pharmacies in rural or underserved areas, reduced hours, and patient impact due to closure and/or acquisition of independent or other retail pharmacies. 

Increased Costs 

Any willing provider laws result in increased costs to the health system as well as increased costs for plan participants. For example, some MCOs achieve economies of scale by owning or operating their own in‐house pharmacies while others achieve cost‐savings by selectively contracting with certain pharmacies to offer increased volume of business in exchange for reductions in pharmacy charges. MCOs also minimize administrative costs by maintaining a select pharmacy network. Any willing provider laws, therefore, undermine the ability of MCOs to achieve and pass along those savings to plan participants. An analysis of states with any willing provider requirements for pharmacies found that there is an association between any willing provider laws and an increase in aggregate costs.¹ 

Quality of Care 

MCOs rely on utilization review and other quality assurance programs to ensure that plan participants receive high‐quality, cost‐effective care. Such programs are effective only if managed care can selectively contract with those providers who satisfy the plan’s quality requirements, and whose performance can be regularly monitored by the plan. Any willing provider laws could potentially increase the likelihood of prescription drug fraud. Selective networks allow MCOs to avoid working with providers suspected of fraud, waste, or abuse.² Any willing provider laws could make it difficult, if not impossible, for an MCO to exclude a pharmacy suspected of fraud from its network. There is a plausible link between any willing provider regulations and increased fraud.³

AMCP Legislative and Regulatory Positions

Revised by the AMCP Board of Directors, July 2024 

Revised by the AMCP Board of Directors, July 2014 

Revised by the AMCP Board of Directors, October 2010 

Revised by the AMCP Board of Directors, October 2003 

Revised by the AMCP Board of Directors, June 2000 

Approved by the AMCP Board of Directors, February 1994 

1 Berenbrok, L.A., et al., Access to Community Pharmacies: A Nationwide Geographic Information Systems Cross-Sectional Analysis (2022). JAPhA. Available at https://www.japha.org/article/S1544-3191(22)00233-3/fulltext 

2 Klick, J. and Wright, J.D., "The Effect of Any Willing Provider and Freedom of Choice Laws on Prescription Drug Expenditures" (2015). All Faculty Scholarship. 438. Available at https://scholarship.law.upenn.edu/cgi/viewcontent.cgi?article=1437&context=faculty_scholarship 

3 Ginsburg, P.B., “Analysis: How Any Willing Provider Makes Health Care More Expensive” (2014). Available at https://www.ahip.org/resources/analysis-how-any-willing-provider-makes-health-care-more-expensive 

4 Id.