The firestorm of controversy over the recent Blue Cross and Blue Shield shift to a limited pharmacy network has given new life to "willing provider" legislation that pharmacists have been seeking for years. Such laws would be a good step toward preserving consumer choice, but must be crafted with care.
State Sens. George Maziarz and Anthony R. Nanula plan to propose a bill next month to bar insurers from excluding any pharmacy willing to meet pharmacy-network or program-contract terms. Such a law would have banned the Blues from shutting out Eckerd, Walgreens or CVS from the deal it cut with Rite Aid, for example.
The catch, for Blue Cross and Blue Shield of Western New York customers angered by that move, is that legislators doubt it can be made retroactive. Although details of the proposed legislation still must be worked out, it seems likely the Blues' network plan will stand and the law would apply only to future deals.
Such a law would benefit consumers by preserving competition, pharmacists' groups argue. Some 40 states now have "willing provider" laws and many add a provision that prescriptions should be filled at "prevailing rates" to prevent big chains from using their size and sales volume to drive small independents out of business, noted John Santarsiero of the Pharmacists' Association of Western New York.
"We've been trying to push this law for seven years," he said.
Blue Cross officials counter that the network plan is about far more than drug costs. Dr. Cynthia A. Ambres, the insurance company's chief medical officer, said Rite Aid offered the Blues what it was seeking in terms of pharmacy service, health and wellness programs, disease prevention and other non-economic services.
Still, the overall goal of the Blues has been to keep costs down, both now and in the future, so it can stay competitive and hold the line on premiums. Rite Aid undoubtedly counted on the economies of volume that could be expected from a large influx of new business. Many Blues members would probably fill their prescriptions at Rite Aid -- or some other network pharmacy -- rather than pay the difference between their health insurance benefits and the costs of service elsewhere.
The local dispute could take an interesting turn, considering rumors that Rite Aid may solve some of its national financial ills by merging with Eckerd, CVS or a retail store chain. Meanwhile, though, state legislation on future deals already is gaining support from downstate legislators facing similar consumer concerns.
In crafting their bill, Nanula and Maziarz will have to be careful to preserve the benefits of competition without eroding efforts to hold down health-care costs. Consumer choice, in this case, could come at the price of increased costs -- and every effort must be made to keep any increase to a minimum.