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Maximum Allowable Cost (MAC) pricing is a payment model contractually agreed to in the marketplace by all participants. The model ensures that those purchasing health insurance benefits, including consumers, do not overpay for generic drugs.
Maximum Allowable Cost (MAC) is a pricing model used by Pharmacy Benefit Managers (PBMs) and payers to reimburse pharmacies for generic drugs or brand name drugs that have generic versions available (multi-source drugs).
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).
Pharmacies will receive payments no higher than the MAC price when billing for drugs on the list. Average value wholesalers sell drugs to physicians, pharmacies, and other. MAC helps contain drug costs for Medicaid. State-level (v. Federal-level) May be a source of revenue for PBMs.
15 Ιουλ 2021 · MAC pricing is the tool that PBMs use to define the upper limit the plan will pay a pharmacy for branded drugs and their multi-source and authorized generics.
15 Οκτ 2018 · MAC lists encourage pharmacies to purchase generics at the lowest possible cost—driving competition among wholesalers and generic drug manufacturers—which ultimately provides value to health plan sponsors and consumers. Who uses MAC lists, and why? Why?
Pharmacy benefit managers (PBMs) calculate the reimbursement for retail pharmacies in their network based on a standard measure called maximum allowable cost, or MAC. MAC pricing has been widely used in the industry, including by the Centers for Medicare and Medicaid Services (CMS) to establish fair reimbursement pricing.
