Any willing provider laws are state statutes that require a health insurer to admit any licensed provider into its network as long as that provider agrees to the plan’s standard contract terms, reimbursement rates, and quality requirements. Roughly 29 states have some version on the books. Most commonly the laws cover pharmacies; some states extend them to physicians, hospitals, or other practitioners. Whether the protection reaches your plan depends on your state and, just as importantly, on whether your insurance is fully insured or self-funded by an employer.
What These Laws Require Insurers To Do
The rule is simple in principle. If an insurer offers a network contract to some providers in a category, it cannot refuse the same contract to other qualified providers in that category. A plan that contracts with a handful of pharmacies in a city cannot turn away a competing pharmacy willing to accept the same reimbursement rates and administrative requirements. The insurer keeps its fee schedule and its quality standards. It loses the ability to pick favorites.
In practice, the insurer publishes standard terms covering payment, billing, credentialing, and quality benchmarks. Any provider meeting those terms gets in. The insurer cannot impose special hurdles on one applicant that it waives for another, and it cannot design requirements so narrowly that only a preferred group can satisfy them.
Enforcement varies. Some states let their insurance commissioner investigate complaints and impose administrative penalties. Others give providers limited recourse, typically through the state insurance department rather than a private lawsuit.
Who Is Actually Covered
The biggest limitation on any willing provider laws is federal. The Employee Retirement Income Security Act of 1974 broadly preempts state laws that “relate to” employee benefit plans.1Office of the Law Revision Counsel. 29 USC 1144 – Other Laws ERISA has a savings clause that preserves state laws regulating insurance, which lets state AWP laws reach fully insured employer plans. The Supreme Court confirmed this in 2003, holding that Kentucky’s any willing provider statutes qualified as laws regulating insurance and were saved from preemption.2Legal Information Institute. Kentucky Association of Health Plans Inc v Miller
ERISA also has a deemer clause that blocks states from treating self-funded employer plans as insurance companies. Self-funded plans, where the employer pays claims directly rather than buying a policy from an insurer, sit outside state insurance regulation altogether.1Office of the Law Revision Counsel. 29 USC 1144 – Other Laws As of 2024, roughly 57 percent of private-sector employees with employer-sponsored coverage were enrolled in self-funded plans. For those workers, state AWP laws do not apply.
The result is that the same provider can be guaranteed network access for one patient, whose employer buys a fully insured plan, and excluded from the network for another patient in the same state whose employer self-funds. Before assuming an AWP law protects you, check whether your plan is fully insured or self-funded. Your benefits handbook or human resources office can tell you.
How AWP Differs From Freedom Of Choice
These two labels get confused often. A freedom of choice law says an insurer must reimburse any covered provider type for services the plan already covers, but it does not force the insurer to add that provider to the contracted network. You can see the provider, and the insurer pays, but the provider is not necessarily in-network, so you may still owe higher out-of-pocket costs.
An any willing provider law goes further. The insurer must actually contract with the provider and include them in the network. That means you pay in-network cost-sharing when you visit that provider, the same copay or coinsurance you would pay at any other in-network location. States that have both types of laws sometimes apply them to different plan types or different categories of providers.
The Federal Any Willing Pharmacy Rule In Medicare Part D
The strongest AWP protection in federal law applies to Medicare Part D prescription drug plans. The statute requires every Part D plan sponsor to contract with any pharmacy that meets the plan’s standard terms and conditions.3Office of the Law Revision Counsel. 42 USC 1395w-104 – Beneficiary Protections for Qualified Prescription Drug Coverage It is not discretionary. If a retail pharmacy agrees to the plan’s reimbursement rates and administrative requirements, the plan must accept it, and the plan must furnish its standard terms within seven days of a pharmacy’s request.
Federal regulations add geographic access standards. At least 90 percent of Medicare beneficiaries in urban areas must live within two miles of a network retail pharmacy, 90 percent in suburban areas within five miles, and 70 percent in rural areas within 15 miles. Plans cannot require a pharmacy to accept insurance risk as a condition of joining the network, and they cannot penalize a pharmacy for telling a patient that a drug costs less at the cash price than through insurance.4eCFR. 42 CFR 423.120 – Access to Covered Part D Drugs
These federal rules operate independently of state law. Even in states without their own AWP statute, Part D beneficiaries get pharmacy network protection.
Which Providers Benefit Most
Retail pharmacies see the most direct impact. Pharmacy claims are high volume and easy to route to specific locations, so without these protections a pharmacy benefit manager could funnel prescriptions exclusively to its own affiliated mail-order operation or corporate chain partners. AWP laws prevent that by guaranteeing independent pharmacies a spot in the network on the same terms. PBMs also cannot design credentialing standards so narrowly that only their own specialty pharmacies can qualify. Where a pharmacy holds the appropriate licenses and can handle the drug category, adding tests that serve no clinical purpose violates the spirit and often the letter of these laws.
Primary care physicians benefit in states whose statute covers physician services, not just pharmacy. A common situation: your employer switches insurance carriers. Without AWP protections, the new insurer could exclude your longtime doctor from its network. Where AWP laws apply, the doctor can join the new network on the same terms offered to existing participants. Professional associations for chiropractors, podiatrists, and mental health professionals have lobbied to expand AWP coverage to their disciplines, with varying success across states.
Hospitals and large health systems are less commonly the focus of AWP legislation, partly because their network contracts are more complex and partly because most states designed these laws primarily with individual practitioners and pharmacies in mind. Specialized outpatient facilities providing dialysis, infusion therapy, or imaging services sometimes invoke AWP laws to reach restrictive networks, which cuts travel for patients who need frequent visits.
What Providers Still Have To Accept
Being in a state with an AWP law is not the same as walking through the door. Providers must first pass credentialing, where the insurer verifies professional licensing, board certifications, malpractice history, and liability insurance. Most network contracts require professional liability coverage, commonly around $1 million per occurrence and $3 million aggregate, though the exact figures vary by plan and provider type.
The provider must also accept the insurer’s fee schedule, which typically pays well below the provider’s standard charges. Those rates are generally non-negotiable. The provider adopts the plan’s administrative systems too: electronic billing formats, prior authorization procedures, and utilization review programs where the insurer evaluates whether care is medically necessary. Failing to participate in those quality and utilization reviews can lead to network termination even in states with AWP protections.
Credentialing timelines are a frequent friction point. Some states impose statutory deadlines requiring insurers to complete the process within a set number of days, often somewhere between 60 and 120. Without such deadlines, applications can sit indefinitely, effectively excluding a provider through inaction rather than a formal denial.
The Cost Tradeoff
AWP laws are popular with providers because they guarantee market access. Insurers and employer groups argue the laws undercut the main cost-containment tool of managed care. Selective contracting lets an insurer negotiate lower rates by promising volume to a smaller group of providers. When every qualified provider must be accepted, that leverage disappears. Research on the topic generally finds that AWP laws are associated with higher health spending, though the size of the effect varies by market and by the categories of providers covered.
Supporters argue the laws promote competition by keeping dominant health systems from locking rivals out of networks, and they point to patient access in rural areas where narrow networks can leave people with no nearby in-network option. That tension between cost and access is why these laws stay contentious decades after the first ones passed, and why the growth of PBM-owned specialty pharmacies has pushed pharmacy-focused AWP proposals back to the center of the policy debate.