Minnesota is considering becoming the 35th state to enact an Any Willing Provider (AWP) policy, which would force insurers to contract with any pharmacy that meets certain terms and conditions.
The AWP language was folded into the omnibus health and human services appropriations bill that is currently before the Minnesota legislature. Proponents argue such laws improve patient choice and help underserved patients. Being able to see one pharmacist for all of a patient’s needs is a major step toward medical safety and patient-doctor relations, the Minnesota Pharmacists Association said.
However, the increase in access comes at a cost. A 2012 study found that by eliminating insurers’ ability to form preferred pharmacy networks, pharmacies had less incentive to compete on price in order to gain favor with an insurer, thus keeping prescription costs high.
“Empirical evidence supports the claim that AWP laws have anti-competitive effects,” the Washington Legal Foundation study said in a finding supported by the Federal Trade Commission.
As for ensuring access to an in-network pharmacy, the Academy of Managed Care Pharmacy (AMCP) argues that insurers already provide for geographically convenient choices. “In fact, many purchasers select a health plan based on its ability to provide broad access for all plan participants by having provider networks in place across many geographic areas,” states a position paper published by AMCP on this issue.
The AWP language in Minnesota’s appropriations bill applies the mandate only to private-sector commercial insurance plans, not public insurance policies.
The Minnesota Chamber of Commerce objected to this particular provision, saying: “We are disappointed that the Senate Finance Committee chose to exempt public programs from this costly new mandate and instead require it only for commercial insurance.”
There are also concerns about compromising the safety of the consumer. Managers regularly use evaluations and quality assurance methods to assess the pharmacies in their networks, making safety another issue that pharmacies compete on for network membership. By ending the selectivity of network membership, it becomes harder for managers to ensure the quality of care their consumers receive. And by encouraging patients to seek only one pharmacist, AWP policies make it harder to get patients to seek out specialists for special prescriptions.
“It’s wrong to make employers contract with drugstores that may not be qualified to dispense these complex specialty medicines,” said Charles Cote, vice president of strategic communications at the Pharmaceutical Care Management Association. Cote also said that no state had proposed AWP language that was as broadly defined as Minnesota’s.
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