Arkansas recently joined an elite group of only three states that have successfully passed PBM transparency legislation. Here are some specifics on the recently passed Maximum Allowable Cost (MAC) bill now Act 1194 of the 89th Arkansas Legislative General Assembly sponsored by Sen. Ron Caldwell (R-Wynne). It addresses issues surrounding MAC payments.
The bill requires:
1.Access to applicable MAC list(s)
2.Timely updates – within seven days of any change on which the MAC is based
3.Prompt notification of MAC updates.
4.A reasonable process for an administrative appeal procedure to allow pharmacies to challenge MACs:
1.If the requirements of the section are not met
2.The cost to the pharmacy is greater than the MAC for the drug in question.
3.The pharmacy must appeal within three business days of the date of service.
4.The PBM shall respond within seven business days.
1. If the appeal is upheld: a) make the change in the MAC; b) permit the challenging pharmacy to reverse and rebill; and c) change the MAC on the list effective for other pharmacies.
2. If the appeal is denied: a) provide the challenging pharmacy with the NDC number used as the basis for determining the MAC is reasonable; and, b) Permit the challenging pharmacy to reverse the claim and submit a new claim.
Bill enforcement is by the Attorney General under the Deceptive Trade Practices Act. This final bill will go into effect 90 days after the official end of the Arkanas legislative session, which was last Tuesday April 23rd, 2013. If you are an Arkansas Pharmacist how do you feel about the bill and does it do enough for you?