MAXIMUM ALLOWABLE COST (MAC) PROGRAM
The Prime Therapeutics Maximum Allowable Cost (MAC) program was developed to help our clients save money on multi-source prescription drugs. Multiple manufacturers create competition in the marketplace often resulting in decreased prescription costs. Typically, generic drugs are introduced at prices ranging from 20 to 50 percent lower than those of the original brand-name product.
The MAC program includes a list of multi-source drugs that are reimbursed at an upper limit per unit price. The MAC for each drug is reviewed quarterly. However, individual products can be adjusted on an as needed basis. If availability of a drug becomes limited, the MAC will be temporarily suspended or the drug may be permanently removed from the MAC list. The drug may be re-added once market sources confirm adequate supply and distribution.
Prime is always looking for opportunities to add products to the MAC list. Considerations for the addition of a drug to the MAC list include:
- Clinical implications of generic substitution
- National availability of generic versions
- Price differences between brand and generic
- Therapeutic equivalence code (Orange Book rating)
- Value for Prime Therapeutics' clients
- Volume of claims
“B” rated drugs, for which actual or potential bioequivalence problems have not been resolved, are not added to the Prime Therapeutics MAC list.
If you are a participating provider and would like access to Prime Therapeutics' MAC list please submit the following information in an email request to MACAccess@PrimeTherapeutics.com.
- Pharmacy/Company Name
- NABP/NCPDP Number
- First Name
- Last Name
- Pharmacy Phone Number
- Pharmacy Fax Number
- Email Address
Once your network participation is verified, you will receive a secure user name and password via e-mail.
INFORMATION ABOUT GENERIC DRUGS:
Health professionals and consumers can be assured that the FDA-approved generic drugs on the MAC list meet the same rigid standards as the brand-name drugs. To gain FDA approval, a generic drug must:
- Contain the same active ingredients as the brand-name drug
- Be identical in strength, dosage form and route of administration
- Have the same use indications
- Be bioequivalent
- Meet the same batch requirements for identity, strength, purity and quality
- Be manufactured under the same strict standards of FDA’s good manufacturing practice regulations required for brand-name products
Based on the FDA’s determination of therapeutic equivalence between generic and brand-name drug products, the FDA concludes that:
- Additional clinical tests or examinations by health care providers are not needed when a generic drug is substituted for the brand name drug
- It is not necessary for health care providers to approach any one therapeutic class of drug products, including drugs regarded as narrow therapeutic range drugs, differently from any other class
Click here for future additions to the MAC list