Management of MAC List for PBM’s Major Retail Pharmacy Contracts

IndustryManaged Care/ PBM
ProblemA PBM client was contracted with various national pharmacy retailers. Included in these contracts were guaranteed Generic Effective Rates (GER) established by the different parties. Appropriate MAC lists were needed to adhere to the agreed upon GER rates for each pharmacy chain.
PHSI SolutionPHSI utilized monthly claims data and current AWP pricing to manage the MAC list for the PBM. Based on utilization data or market place changes, PHSI was able to adjust the MAC list accordingly while meeting the contracted GER.
ResultsRoutine management of the MAC list allowed the PBM to follow through on the GER guarantees. PHSI was able to address any possible deviations early in the year rather than during an annual review. The client maintained beneficial relationships with the retail chains and prevented financial penalties. PHSI continues to monitor market pricing and utilization data to update the MAC lists to continue meeting these GERs.