Citizens Against Government Waste decry ‘any willing provider’ provision

Citizens Against Government Waste (CAGW) again has voiced opposition to any state or federal legislation that would enact an “Any Willing Provider” provision to Medicare Part D.
  
New Jersey Assembly Concurrent Resolution No. 222 is one of the latest to urge Congress to enact a federal law recognizing such provisions to the Medicare prescription drug plan, which would require health insurance carriers to allow health care providers to become members of the carriers’ networks of providers if certain conditions are met.
 
“Adopting such a plan would drive up costs,” Elizabeth Wright, CAGW’s health and science director, told American Pharmacy News. "Yes, we are against it."

Numerous states, in fact, already have Any Willing Provider laws, which prohibit — either broadly or in a limited capacity — insurance carriers from limiting membership within their provider networks based on geography, for instance, or other characteristics as long as a provider is willing and able to meet the conditions of network membership set by the carrier.
   
In a nutshell, such laws require managed care plans to accept any qualified provider that is willing to accept the terms and conditions of a managed care plan. While they don’t have to contract with all providers, managed care plans do have to explicitly state evaluation criteria and ensure due process for providers that want to contract with the plan.
   
States having some form of Any Willing Provider laws, according to PBM Watch, are:  Alabama, Arkansas, Colorado, Connecticut, Delaware, Florida, Georgia, Idaho, Illinois, Indiana, Iowa, Kentucky, Louisiana, Maine, Massachusetts, Mississippi, Missouri, Montana, Nebraska, New Hampshire, New Jersey, North Carolina, North Dakota, Oklahoma, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Wisconsin and Wyoming.
   
Wright said that pharmacy benefit managers (PBMs) are utilized by insurers, labor unions, and employers, as well as in Medicare Part D and the Federal Employees Health Benefits Program, to manage their pharmacy benefit plans.
  
“PBMs vigorously negotiate with pharmaceutical companies and pharmacies to get the best deal they can for their customers and by offering services, such as mail-order delivery, that is convenient for patients," she said. "PBMs utilize preferred pharmacy networks, where pharmacies will offer lower prices in exchange for greater patient volume."
  
Consumers and pharmacies stand to be negatively affected, Wright said, pointing to Federal Trade Commission (FTC) comments on 2015 policy and technical changes to Medicare Part D. The FTC said that "any willing pharmacy" provisions threaten the effectiveness of selective contracting with pharmacies as a tool for lowering costs.
   
Specifically, Wright pointed out, requiring prescription drug plans to contract with any willing pharmacy would reduce the ability of plans to obtain price discounts based on the prospect of increased patient volume and thus impair the ability of prescription drug plans to negotiate the best prices with pharmacies.
  
“Usually, ‘Any Willing Pharmacy’ laws are pushed in state legislatures and Congress by independent pharmacies. They are trying to leverage the government to force PBMs to accept them in their preferred pharmacy network,” Wright said.
   
And because CAGW works to eliminate waste, fraud, abuse, and mismanagement in government through research and public education activities, she said, if any pharmacy can participate, then the promise of increased volume for lower prices is negated and costs will go up for taxpayers and patients.
  
Rather than enact an "Any Willing Provider" provision, the federal government instead should do nothing, Wright said.
  
“It should allow the market and competition to work and stay out of micromanaging Medicare Part D,” she said.
   
In fact, she said, the Medicare prescription drug plan has been one of the most successful government programs ever created and the key to that success has been the “non-interference” clause in the law that allows private sector providers to compete with one another without government meddling.
  
“As the saying goes: if it ain't broke, don't fix it,” Wright said.