Generic MAC File Services

As generic pharmaceutical dispensing rates approach 85%, effective management of Maximum Allowable Cost (MAC) lists has become an important strategic business issue for PBMs and managed care organizations (MCOs). Generic pricing is influenced by many factors, including: 180-day exclusivity, launch of an authorized generic, the number of generic suppliers, product recalls, and raw material sourcing. PHSL provides comprehensive MAC File Services or a periodic independent review of your MAC list(s). Our MAC clients depend on PHSL to provide accurate and timely MAC updates as market dynamics dictate.

As state and federal laws change to require more frequent MAC monitoring, PHSL can provide services to comply with new requirements.

Comprehensive Support Available

PHSL provides a turnkey solution where MCOs and PBMs outsource the management of their MAC program to PHSL. Customized MAC lists are created by:

• Understanding pharmacy network contracts relative to generic reimbursement
• Creating a MAC philosophy tailored to meet your organization’s needs
• Reviewing current MAC list(s) or PHSL creating an initial MAC file
• Measuring current MAC effective rate and/or quantifying impact of PHSL-created MAC list
• Conducting weekly, monthly, or quarterly MAC file reviews with ad-hoc updates as market changes dictate
• Scheduling quarterly MAC file meetings to review performance
• Monitoring the count of generic suppliers to identify when products no longer qualify for MAC pricing

PHSL uses various pricing sources to determine appropriate MAC prices, including CMS, Medi-Span and First Databank (FDB), and review of actual pharmacy costs. MAC files can be customized to use GPI, GCN, GSN, or NDC.

PHSL offers a Single Source Generic File Program that is used by clients to determine products to exclude from the generic discount guarantee. The file is delivered biweekly, identifies generics with one supplier, and includes a list of products that may have one or zero available competitors resulting in market supply issues.

Ad-Hoc MAC File Support

From time to time, MCO and PBM clients desire an independent evaluation of their MAC lists. PHSL conducts the evaluation by reviewing pricing and MAC list breadth, and identifies gaps where products could be added or deleted from the list. Ad-hoc MAC file reviews are a great way for plans that do not own their own pharmacy networks to audit and measure the competitiveness of their network provider’s MAC prices.

View our case studies related to MAC File Support:

PHSI Designs MAC Pricing Benefiting HMO and Retail Pharmacy

Customized MAC List Reduces Generic Spend for a Medicaid Client

PHSI Creates Pharmacy Chain MAC to Meet PBM Contract GER Guarantee