The Impact of Pharmacy-Specific Any-Willing-Provider Legislation on Prescription Drug Expenditures

Many states have implemented some form of Any-Willing-Provider (AWP) legislation, which requires a managed care organization (MCO) to accept any provider, who agrees to the managed care organization’s reimbursement rates, terms, and conditions, into its network. AWP laws may result in larger networks, more patient choice, and greater competition among providers. Opponents cite AWP legislation as prohibiting managed care organizations from selective contracting and obtaining discounts by offering providers a larger volume of patients. Such legislation is therefore argued to prevent MCOs from effectively reducing health care costs. A small literature exists on the effect of these laws on hospital expenditures, physician expenditures, and total health care expenditures. Most studies, however, fail to recognize that the vast majority of the existing laws target pharmacies exclusively, as opposed to more comprehensive laws that also apply to physicians and hospitals. If AWP legislation prevents cost reduction available through selective contracting, then states with such legislation may incur higher health care expenditures. I find that pharmacy-specific AWP legislation is associated with increased pharmaceutical expenditures. This result is robust to several alternative specifications. Copyright International Atlantic Economic Society 2009