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MAC Law 50 State Survey

 

Published on August 8, 2017

Overview

The Academic Medical Centers and Teaching Hospitals; Hospitals and Health Systems; In-House Counsel; Life Sciences; and Payers, Plans, and Managed Care Practice Groups are pleased to announce the release of “Pharmacy Maximum Allowable Cost (MAC) Laws: A 50 State Survey.”


This 50 state survey on pharmacy maximum allowable cost (MAC) laws summarizes the laws of each state regarding how they govern the way payers—including pharmacy benefit managers (PBMs)—can reimburse pharmacies for products dispensed to patients. This survey also looks into each state's position on:

  • Whether drugs have to meet certain conditions for inclusion on the MAC list;
  • Whether the PBM is obligated to provide the MAC list and/or related information to pharmacies;
  • Whether the PBM is obligated to update its MAC list;
  • Whether pharmacies can appeal the reimbursement level on MAC lists;
  • Whether the PBM has to provide any specific information to assist the pharmacy in filing its appeal;
  • Whether there are any specific mandated deadlines concerning the appeals process;
  • Whether there is any mandated course of action if the appeal is upheld or denied; and
  • Whether the state has any other notable statutory requirements.


Survey           

Pharmacy Maximum Allowable Cost (MAC) Laws: A 50 State Survey


Authors and Editors

Special thanks to the authors and editors of this resource:

Author

  • Emma J. Chapman, JD/MPP 2018 (Georgetown University Law Center McCourt School of Public Policy, Washington, DC)

Editors

  • Greg Mitchell (Express Scripts, Inc., St. Louis, MO)
  • Leah Stoecker (Express Scripts, Inc., St. Louis, MO)
  • Cori Casey Turner (Husch Blackwell LLP, Kansas City, MO)
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