Pending State Maximum Allowable Cost Legislation
PENDING STATE MAC LEGISLATION (2013 LEGISLATIVE SESSIONS)
Georgia:
H.B. 413 - Defines Maximum Allowed Cost to not include dispensing fees, copays, coinsurance or other cost-sharing charges. Sets a time table for PBMs to disclose the source their methodology for determining MAC prices as well as a requirement for PBMs to provide updated pricing information to pharmacies.
Maryland:
H.B. 908 - Requires PBMs in their contracts with pharmacies to provide information relating to their MAC prices for certain prescription drugs as well as update with a certain frequency their MAC prices, as well as other protections for pharmacies and consumers.
Massachusetts:
H 1521 - Would require PBM contracts to include which third-party database the PBM used to calculate its MAC rates.
New Jersey:
A 679 - Would set that with respect to any MAC pricing system a PBM shall not reimburse a retail pharmacy for a prescription drug under any prescription plan, in an amount less than the retail pharmacy's acquisition cost for the drug
Oregon:
S.B. 402 - Requires PBMs to specify methodology for determining MAC prices as well as creates a process for adjudication if the pharmacy disputes the MAC price. Also specifies the frequency for which the MAC cost must be updated.
Oklahoma:
H.B. 2100 - Requires PBMs to include in contracts with pharmacies the methodology and sources used to determine MAC as well update the MAC pricing lists every 7 calender days. Provide a reasonable administration appeals procedure to allow a pharmacy to contest MAC rates.
Pennsylvania:
To be introduced soon - This will require PBMs to provide clarity on how MAC pricing is established for pharmacies and plan sponsors.
Texas:
H.B. 3262 - Would amend various Texas Insurance Codes to require PBMs to provide calculation of MAC pricing in contracts, publish on a website, and provide the information to a pharmacy or pharmacists upon request.
Georgia:
H.B. 413 - Defines Maximum Allowed Cost to not include dispensing fees, copays, coinsurance or other cost-sharing charges. Sets a time table for PBMs to disclose the source their methodology for determining MAC prices as well as a requirement for PBMs to provide updated pricing information to pharmacies.
Maryland:
H.B. 908 - Requires PBMs in their contracts with pharmacies to provide information relating to their MAC prices for certain prescription drugs as well as update with a certain frequency their MAC prices, as well as other protections for pharmacies and consumers.
Massachusetts:
H 1521 - Would require PBM contracts to include which third-party database the PBM used to calculate its MAC rates.
New Jersey:
A 679 - Would set that with respect to any MAC pricing system a PBM shall not reimburse a retail pharmacy for a prescription drug under any prescription plan, in an amount less than the retail pharmacy's acquisition cost for the drug
Oregon:
S.B. 402 - Requires PBMs to specify methodology for determining MAC prices as well as creates a process for adjudication if the pharmacy disputes the MAC price. Also specifies the frequency for which the MAC cost must be updated.
Oklahoma:
H.B. 2100 - Requires PBMs to include in contracts with pharmacies the methodology and sources used to determine MAC as well update the MAC pricing lists every 7 calender days. Provide a reasonable administration appeals procedure to allow a pharmacy to contest MAC rates.
Pennsylvania:
To be introduced soon - This will require PBMs to provide clarity on how MAC pricing is established for pharmacies and plan sponsors.
Texas:
H.B. 3262 - Would amend various Texas Insurance Codes to require PBMs to provide calculation of MAC pricing in contracts, publish on a website, and provide the information to a pharmacy or pharmacists upon request.