Pharmacists and pharmacies nationwide are constantly fighting for network inclusion with Pharmacy Benefit Managers (PBMs) and various payors. One of the issues that has been frustrating the pharmacy community are the various interpretations from the PBM and payor community regarding how they read Any Willing Provider statutes vs. how the pharmacists read the law.
Status of Any Willing Provider Laws
This legislative session has seen two states address some form of expanded access for pharmacy: Oklahoma through SB 841 and Louisiana through SB 41. There are currently 26 states that have any willing provider laws that expressly applies to pharmacies. However, there are 10 other states that have Any Willing Provider laws, but they apply either generally to “providers” or are otherwise expressly limited to only certain types of providers which do not include pharmacies. Pharmacies should not assume that that they are covered just because their state has an Any Willing Provider law. Sometimes that may not be the case.
Pharmacies need to recognize whether their state is a “true” Any Willing Provider. Even if there is a law in place, often a state’s language can either be tightened or clarified. Frier Levitt Government Affairs (FLGA) works with pharmacies, pharmacy organizations, and other stakeholders regarding language to use to improve their position and opportunities regarding Any Willing Provider laws. Additionally, FLGA provides lobbying for stakeholders on the state level to help them get into more networks, reach more potential patients, and expand their margins.
Contact Frier Levitt Government Affairs today for help with Any Willing Provider laws and expanding more market opportunities.