MAC Appeals

A pharmacy may submit a MAC pricing appeal via:

• Email at MACAppeals@primetherapeutics.com
• Fax at 877.823.6373. If a fax is sent, an email address is required so a response may be provided.

Please use the attached form for your submission.

Maximum Allowable Cost (MAC)

MRx Maximum Allowable Cost (MAC) program lists pricing for drugs that are reimbursed at an upper limit per unit price, based on current market sources. All products are reviewed on a regular basis and will be adjusted as needed based on market conditions. MRx MAC lists are updated at a minimum of every seven (7) days or in accordance with applicable law. If the availability of a drug becomes limited, the MAC will be suspended or the drug may be permanently removed from MAC lists at MRx's sole discretion. The drug may be added back when MRx market sources confirm adequate supply and distribution.

The sources currently used to determine MAC pricing are regional and national wholesalers, the National Average Drug Acquisition Cost (NADAC) published by CMS, Predictive Acquisition Cost (PAC) pricing and Medi-Span. MRx may change pricing sources at any time.

MAC list will be available upon request and can be obtained by sending a request to rxnetworksdept@magellanhealth.com.