Requirements which dictate the frequency with which MAC lists must be updated, and that establish a statutory process for notification, including who must be notified and the exact timing of notification.Requirements that payers may only use specific sources for setting MAC payment rates on each list included under a contract, and that payers must specify the sources utilized for each list and each client.All federal or state requirements with respect to MAC list calculations, including requirements that payers disclose to pharmacies the proprietary methodology used to calculate pharmacy MAC reimbursement.This may drive up drug prices for health plans, employers, other payers, and consumers. Similarly, if MAC pricing policies are opaque or unpredictable to community pharmacies, it may impact the long-term sustainability of pharmacies to provide care for members of their community.ĪMCP strongly supports market-based competition and reasonable contractual negotiation between private parties.Īccordingly, AMCP would oppose the following:

Competing health plans would have access to others’ pricing information and MAC reimbursement calculations, allowing both the potential opportunity to price fix. If MAC price information is publicly disclosed, it would have an anti‐competitive effect on health plans, employers, and other payers. MAC pricing policies must balance the need for confidentiality with the pharmacies’ need for predictable reimbursement. Payers and pharmacy benefit managers (PBMs) operate in a highly competitive environment therefore, it is essential to ensure that their contracted pharmacies are encouraged to purchase less costly generics available in the market. In general, market competition reflected in MAC pricing supports payers’ goals of keeping drug costs down for consumers and payers and not overpaying for generic drugs. Drugs that have been generic longer are more likely to have greater competition and, therefore, lower pharmacy‐purchasing prices. MAC prices are driven by factors inherent in marketplace competition, including how long the drug has been generic, how many manufacturers are making generic versions, how widely available the generic drug is accessible for purchase, and whether there have been problems in manufacturing (such as access to basic ingredients or product recalls). MAC pricing plays an important role in keeping economic incentives aligned for both payers and pharmacies. Alternatively, if they purchase generic drugs at a more favorable price, they are more likely to make a profit. If a pharmacy purchases the higher‐priced product, it may not make as much profit or, in limited instances, may lose money on that specific purchase. MAC pricing is designed to promote competitive pricing for pharmacies as an incentive for them to purchase less costly generic drugs available in the market, regardless of the manufacturer’s list price, since manufacturers will charge different amounts for equally interchangeable generic drugs. AMCP supports the use of MAC pricing as a managed care tool to encourage the dispensing of cost-saving generic drugs and thereby benefiting the overall health care system. MAC price reimbursement is an effective pricing tool because MAC prices are updated frequently to keep pace with market changes in the purchase prices of generic drugs available to pharmacies. The model ensures that those purchasing health insurance benefits, including consumers, do not overpay for generic drugs. Maximum Allowable Cost (MAC) pricing is a payment model contractually agreed to in the marketplace by all participants. Managed Care Pharmacy Residency Director/Preceptor Award.Fellow of the Academy of Managed Care Pharmacy FAMCP Application Packet.Pharmacy Pay-for-Performance Principles.Pre-approval Information Exchange (PIE).Diversity, Equity & Inclusion (DEI) Glossary.Drug Product Pipeline Portal (Member View).Drug Product Pipeline Portal (Limited View).Medication Use Quality Continuing Education Program.AMCP Summit: Addressing Health Disparities.Managed Care Pharmacy PowerPoint Presentations.

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