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
March 2019 Question of the Month
How will the HHS proposed rule changes to Medicare Part D and Medicaid drug rebate safe harbors impact pharmaceutical product net costs for PBMs?
Higher net costs after the implementation of the proposed rule: 50%
Lower net costs after the implementation of the proposed rule: 12.5%
No impact, net costs will be at the same levels as today: 37.5%
February 2019 Question of the Month
What is the likelihood brand pharmaceutical manufacturers will slow drug price increases in 2019 based on the Trump administration’s proposals?
Highly Likely: 0%
Likely: 12.5%
Unlikely: 75%
Highly Unlikely: 12.5%
January 2019 Question of the Month
Are there more challenges with the new lower priced Repatha NDC compared with the higher priced NDC?
Yes: 57.1%
No: 42.9%
Do you think brand manufacturer’s strategy to introduce a lower priced brand NDC of an existing product is going to expand in 2019?
Yes: 85.7%
No: 14.3%
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