The time has come for pharmacists to work on reforming the maximum allowable costs put forth by the pharmacy benefit managers
Most complaints I hear invariably lead back to a dreaded three-letter combination: PBM (pharmacy benefit managers). One of the PBMs' most pernicious business practices revolves around another dreaded three-letter combination: MAC (maximum allowable costs). It sounds innocuous. After all, what is problematic about a list of products that includes the maximum amount a plan will pay for generic drugs and brand-name drugs that have generic equivalents?
Lack of standards
Independent community pharmacies are not informed of how products are added or removed from a MAC list or of the methodology for calculating reimbursement - which can change in an instant. In other words, our members sign contracts with the PBMs for inclusion in their pharmacy networks, but are operating blindly under these reimbursement models.