The MAC pricing system must be fixed

June 15, 2012

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.