Health Insurance Marketplaces

Any Willing Provider Legislation

Policy 9901

11/01/1999 Introduced
03/01/2004 Reapproved
02/01/2005 Revised
01/01/2009 Reapproved

07/29/2014 Revised

AMCP supports the ability of managed care organizations to selectively contract with only those providers necessary to enable the organization to provide patients with adequate access to pharmacy services and quality, cost-effective health care. By selectively contracting with providers, managed care organizations assure that patients can receive the best care, have access to the providers they need and reduce the likelihood that valuable health care resources will be wasted through inappropriate use. Therefore, the Academy opposes legislation that would require managed care organizations to contract with any provider meets the terms and conditions of the organization, whether or not it can be shown that the provider meets the geographic access needs and/or quality standards of the health plan.

(See AMCP Managed Care Pharmacy Practice Positions - Any Willing Provider Legislation)

Government-Mandated Pharmacy Benefits

Policy 0101

03/01/2001 Introduced
06/01/2006 Revised

02/13/2019 Reapproved

AMCP supports the right of managed care organizations and their clients to independently make decisions with regard to health benefits that meet the medical needs of specific patient populations while being compassionate, medically sound, timely, and fiscally responsible. Federal and state legislation and regulations should not hinder a health care delivery system's ability to provide customized benefits that assure value and quality patient care for specific patient populations, yet remain affordable.

(See AMCP Managed Care Pharmacy Practice Positions - Government-Mandated Pharmacy Benefits)

Prescription Drug Coverage

Policy 9925

11/01/1999 Introduced
03/01/2004 Reapproved
12/01/2008 Revised
10/01/2012 Revised

04/12/2021 Revised

03/29/2022 Revised

AMCP supports the inclusion of prescription drug coverage in all health care benefit programs, including those administered by the government (e.g., Medicare, Medicaid, health insurance exchanges). Access to and proper utilization of a comprehensive prescription drug benefit, have been shown to reduce the severity of and complications arising from many common illnesses. Failure to provide prescription drug coverage can increase the use of more intensive, costly health care services, such as surgery and/or hospitalization. AMCP also supports granting flexibility to managed care organizations to develop clinically sound, evidence-based benefits free from arduous mandates.  
 
(See AMCP Managed Care Pharmacy Practice Positions - Prescription Drug Coverage).  

Co-payment Offset Programs

Policy 1302

02/01/2013 Introduced

AMCP is supportive of programs that help patients afford their prescription drugs. However, some programs can needlessly encourage the use of more expensive brand-name products over their generic counterparts. They can also undermine the formulary development process by encouraging the use of products that have lower cost therapeutic alternatives. Patient safety can also be threatened when prescriptions are frequently transferred between retail pharmacies. Therefore, AMCP is opposed to manufacturer coupon programs that are promotional in nature and are not means-tested.

(See AMCP Managed Care Pharmacy Practice Positions - Co-Payment Offset Program)

Regulation of the Prescription Drug Benefit

Policy 1402

10/07/2014 Introduced

04/12/2021 Revised

AMCP recognizes that government should encourage an environment in which managed care pharmacists continue to develop innovative and integrated strategies to manage prescription drug benefits for a given patient population. AMCP supports statutory and regulatory efforts that will continue to enable the ability of managed care pharmacists to consider the range of clinical, legal, quality-of-life, safety, and pharmacoeconomic factors which form the basis for the design and implementation of effective drug benefit strategies and programs. However, the Academy opposes statutory and regulatory proposals that unduly restrict the ability of managed care pharmacists from using proven tools and practices, such as drug utilization review, formulary management, utilization and network management, that are essential for the management of a prescription drug benefit. These types of proposals are objectionable if they go beyond procedural protections and enter an arena traditionally within the purview, expertise and experience of health care professionals. Unnecessary or overly burdensome regulatory restrictions could place patients at risk and increase the cost of health care. The result could compromise the availability and affordability of the prescription drug benefit.

(See AAMCP Managed Care Pharmacy Practice Positions - Regulation of the Prescription Drug Benefit)