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Maximum Allowable Cost ("MAC"): MAC prices are the upper limits that a pharmacy benefit manager ("PBM") or prescription drug benefit plan will pay a pharmacy for generic drugs and brand name drugs that have generic versions available (multi-source brands).įree Online QR Code Generator to make your own QR Codes. The problem with MAC pricing:PBMs use arbitrary and opaque MAC pricing to derive record profits at the expense of independent pharmacies, plan sponsors and most importantly consumers. The lack of transparency surrounding MAC pricing allows PBMs to pay aggressively low reimbursement to pharmacies while charging significantly higher amounts for the for the same drug to plan sponsors, pocketing this "spread" at the cost of consumers. Legislative solutions: A number of states have recently passed legislation or have legislation pending that is designed to provide clarity on PBMs' derivations of MAC pricing, and standardization for how products are selected for inclusion on MAC lists.Īct 1194 - Regulates how drugs can be put on the MAC list as well as requires the MAC lists be made available to pharmacies. The act also requires that necessary updates be performed on the MAC list every 7 days. It also creates an appeals process for pharmacies to dispute MAC price billing with PBMs. HF 2297 - This law regulates PBM management of Maximum Allowable Costs.
Among the various provisions is a requirement for the PBM to include in its contract information regarding which of the national compendia is used to obtain pricing data used in the calculation of the maximum reimbursement amount pricing and a process to allow a pharmacy to comment on, contest, or appeal the maximum reimbursement amount rates or maximum reimbursement amount list. 107 - Requires the PBMs to identify the sources used for their drug price data as well give the contracted pharmacies the actual cost MAC for each drug.
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