PHSI Designs MAC Pricing Benefiting HMO and Retail Pharmacy

IndustryManaged Care/ PBM
ProblemA Medicaid HMO wanted to ensure that their Maximum Allowable Cost (MAC) list was controlling generic expenditures while providing a reasonable profit to their retail pharmacy networks.
PHSI SolutionPHSI created a unique model to analyze the costs associated with generic drugs in order to create competitive MAC lists incorporating the needs of all market segments. The MAC list aligned incentives for all stakeholders to promote generic substitution.
ResultsThe Medicaid HMO aligned financial incentives while increasing their generic substitution rate and lowering network complaints on generic pricing.