PHSI Designs MAC Pricing Benefiting HMO and Retail Pharmacy
| Industry | Managed Care/ PBM |
| Problem | A 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 Solution | PHSI 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. |
| Results | The Medicaid HMO aligned financial incentives while increasing their generic substitution rate and lowering network complaints on generic pricing. |
Poll Results
September 2018 Question of the Month
How will the addition of step therapy on Medicare Part B drugs impact biosimilars?
Increase use of biosimilars: 54.55%
No Change: 36.36%
Decrease biosimilar use: 9.09%
August 2018 Question of the Month
Will deeply discounted WAC prices (list price) for biosimilars and specialty generics influence uptake?
Yes: 28.6%
Some impact: 57.1%
No: 14.3%
July 2018 Question of the Month
What is your opinion on pharmacists being allowed to refuse to dispense a prescription for ethical reasons?
Agree: 12.5%
Agree, if they can find another reasonable option for the patient: 56.25%
Disagree: 25%
Indifferent: 6.25%
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