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
November 2018 Question of the Month
Do you believe there are sufficient treatment options for HIV to warrant formulary exclusions?
Yes: 75%
No: 25%
Do you believe there are sufficient treatment options for Hemophilia to warrant formulary exclusions?
Yes: 71%
No: 29%
Do you believe there are sufficient treatment options for Hereditary Angioedema to warrant formulary exclusions?
Yes: 17%
No: 83%
October 2018 Question of the Month
How will state regulation and licensure of PBMs impact retail pharmacies? (select all that apply)
Improve pharmacy reimbursement rates: 5.88%
Add transparency to Rx reimbursement: 35.29%
Reduce PBM conflict of interests: 17.65%
Eliminate retrospective financial clawbacks: 17.65%
No impact: 11.76%
Reduce pharmacy reimbursement rates: 11.76%
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%
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