In the face of rising drug prices, many lawmakers have instituted policies that only worsen the situation, such as banning efficient pharmacy networks, restricting mail-order pharmacies and restricting maximum allowable costs, claims Herrick.
NCPA favors the use of a wholesale acquisition cost [WAC]-based reimbursement benchmark for brands and an appropriately determined state maximum allowable cost [MAC] approach for multiple-source drugs with three or more sources of supply," states the letter, signed by NCPA senior vice president of government affairs John Coster.
7,8) The lower reimbursements from Part D plans/ PBMs are due to the maximum allowable costs (MACs)--the upper limit for drug reimbursements set by plans/ PBMs--being low relative to the actual cost of drug purchases.
Meanwhile, state lawmakers nationwide are discussing such steps as reduction in Medicaid pharmacy payments, cuts in dispensing fees, brand-drug limits, prescription limits, preferred drug lists (PDLs)*, state maximum allowable costs, generic substitution, prior authorization and assisted-living-related medication management, among others.
In publishing three draft lists of Medicaid drug FULs, CMS has provided states with a potential unofficial standard for setting state maximum allowable costs (MACs)," a group of 14 senators wrote in a letter to CMS earlier this year.
1058), legislation that would reduce costs and give patients greater choice while addressing pressing pharmacy issues such as abusive auditing practices and confusion regarding maximum allowable costs (MACs).