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
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%
December 2018 Question of the Month
Will there be a(n) ______ number of pharmaceutical product price changes in 2019 compared to 2018?
Increased: 63.64%
Decreased: 0.00%
Similar: 36.36%
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%
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