MAC Pricing Methodology

Introduction

PDMI maintains a Maximum Allowable Cost (MAC) pricing program to be used for pharmacy provider reimbursement on Generic products. The MAC program aligns the incentives for the health plan or payer, the patient, and the pharmacy. The MAC pricing will ensure cost effective generic drug purchasing habits while maintaining reasonable pharmacy profit incentives to dispense market appropriate generic equivalent products.

Criteria for MAC Application

The following criteria are used for inclusion on the PDMI MAC list:

  • Generic profitability is maintained to create appropriate pharmacy incentives for dispensing generic products
  • Typically, at least two AB-rated multisource generic products are readily available in the marketplace
  • Typically, non AB-rated products, DESI drugs, injectable products, and repackaged products are generally not included in MAC pricing application
  • Pricing Factors:
    • Actual medication purchase price
    • 180-day exclusivity
    • Launch of an authorized generic
    • The number of generic suppliers
    • Product recalls
    • Raw material sourcing
    • Other market influences

Methodology

PDMI utilizes actual pharmacy acquisition cost data to calculate MAC prices. The methodology creates incentives for pharmacies to wisely purchase drugs in the competitive generic market. MAC prices are set based on multiple wholesaler pricing tables used to determine adequate reimbursement for a generic equivalent product. PDMI sets its MAC pricing at the GPI level, per Medi-Span drug information formats. This helps to ensure that nearly all pharmacies are receiving the appropriate reimbursement for a generic equivalent product while incentivizing wise purchasing practices. 

MAC Updates

The PDMI managed network MAC application undergoes a review on a weekly basis to account for potential market fluctuations that can impact wholesale acquisition costs. If the review results in an indication for a change in a MAC price for a given GPI, the MAC price will be updated accordingly in real time with an appropriate effective date.