Achieving MAC Transparency

The Center for Medicare & Medicaid Services (CMS) has approved the final ruling regarding the disclosure and updating of Maximum Allowable Cost (MAC) reimbursement limits. The effective date of the ruling is slated for January 1, 2016. The new ruling brings Medicare Part D rules closer to the MAC Transparency rules adopted by many states.

While CMS’s ruling applies only to Medicare plans, many states are ruling more broadly and enforcing new laws for PBM’s in general.

The new CMS ruling requires all Medicare Part D plans and their pharmacy benefit managers to make their MAC pricing standards available to their network pharmacies, including the source or methodology for setting those prices.

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