Maximum Allowable Cost (MAC) Pricing and Appeals

As Pharmacy Benefit Mangers (PBMs) ramp up their methods of minimizing profit margins for independent pharmacies, several states have recognized the troubles independent pharmacies face with PBM tactics regarding Maximum Allowable Cost (MAC) for multisource generic drugs. These states have passed laws on MAC pricing and the corresponding appeals process, with some states even enacting laws that afford their resident pharmacies additional protections under their business tort laws. In some instances, a PBM’s failure to follow MAC pricing laws may constitute a deceptive and unconscionable trade practice, exposing the PBM to direct claims by the pharmacy for monetary damages and attorneys’ fees. Because of variations in state law and PBM processes, knowledgeable legal counsel is critical to fully understanding your legal rights regarding MAC.

Frier Levitt’s MAC Reimbursement Rights Practice Group counsels pharmacies on:

Pharmacies that dispense a substantial amount of multisource generic drugs and have concerns regarding PBM MAC practices should contact us today to speak with an attorney.