In processing payments to contracted pharmacies, what reimbursement program do almost all PBMs use?

The maximum allowable cost (MAC) is the reimbursement program used by almost all Pharmacy Benefit Managers (PBMs) when processing payments to contracted pharmacies. MAC serves as a pricing mechanism that establishes a set maximum price that a PBM will reimburse pharmacies for dispensing specific generic medications. This approach helps manage and control drug spending by ensuring that reimbursement rates are standardized for certain drugs, allowing PBMs to negotiate costs effectively and promote the use of more cost-effective generic options over brand-name drugs.

By implementing MAC, PBMs can encourage pharmacies to opt for more affordable alternatives without sacrificing the quality of care provided to patients. The use of MAC aligns with the overall goals of controlling healthcare costs and increasing the efficiency of the pharmacy benefit management process.