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What is a State Maximum Allowable Cost (State MAC) rate schedule?
State Maximum Allowable Cost (State MAC) rate schedules are based on the premise that chemically equivalent drug products in the same strength and dosage available from multiple sources should be reimbursed similarly. State MAC rates are designed to maximize the cost-effectiveness of pharmacy services by setting reimbursement amounts for therapeutically equivalent drug products at the same price, based on the cost of the products. The Centers for Medicare and Medicaid Services (CMS) uses this same premise to establish federal upper limits (FULs) for drug products. State MAC rates are essentially the state Medicaid program version of CMS FULs.
Why might Wyoming Medicaid request information about my pharmacy’s drug purchases?
In order to maintain a State MAC program with reimbursement that reflects current pharmaceutical market conditions, the State MAC rate schedule is based on the actual acquisition costs of Medicaid pharmacy providers. The calculated rates are designed to reimburse ingredient costs, considering the prices pharmacies must pay in order to acquire the selected drugs and pharmacies’ need for flexibility in the acquisition of proper drugs to fill prescriptions.
The State MAC rate schedule is based on Medicaid pharmacy providers’ actual experiences purchasing selected drug products. Individual providers’ ability to purchase drug products at or below the established State MAC rates will be contingent on representation in the purchase information the Department uses to establish and maintain the State MAC rate schedule. Providers who receive requests for drug purchase information are encouraged to provide the requested information to insure that the established State MAC rates fully consider providers’ cost experience in the marketplace.
What will Wyoming Medicaid do with drug purchase information it receives from me?
The Department will use drug purchase information submitted by pharmacies for the purpose of establishing, evaluating, maintaining, and updating a State MAC rate schedule. The Department has contracted with the firm of Myers and Stauffer to assist in developing and maintaining the State MAC. Pharmacies are encouraged to submit copies of purchase information, rather than originals. If originals are sent, arrangements should be made in advance with Myers and Stauffer for the return of original purchase information.
Why might my pharmacy be selected to provide drug purchase information?
All pharmacy providers enrolled in the Wyoming Medicaid program are eligible for random selection to provide drug purchase information to the Department and Myers and Stauffer.
How often might I be asked to provide drug purchase information?
All pharmacy providers enrolled in the Wyoming Medicaid program are eligible for selection to provide drug purchase information. Periodically, Myers and Stauffer will request purchase information from a sample of identified pharmacy providers. It is not anticipated that any pharmacy location will be selected more frequently than twice per year, and most pharmacies will only be selected once per year or less often.
The Department recognizes that changes in pharmaceutical prices and product availability occur on a regular basis. In addition, the Department recognizes that the most current, and reliable information regarding changes in acquisition cost and product availability will be provided by pharmacies. The Department will obtain and review industry data, such as published pricing information, and information provided by Wyoming pharmacies to frequently assess the State MAC program and to insure that State MAC rates reflect current pharmaceutical market conditions. To respond to changes in the pharmaceutical market that may impact the price and/or availability of drug products, adjustments to the State MAC program will be made periodically as needed.
Providers may also request that the Department review State MAC prices for particular drugs. Providers who wish the Department to consider adjustments to State MAC rates may make such a request by contacting the Department or Myers and Stauffer in writing by e-mail, regular mail or toll free telephone. When making such a request, providers will be asked to provide as much information as possible to assist the Department and Myers and Stauffer in understanding the specific issue being raised and the provider’s desired outcome. Helpful information should include but not be limited to drug purchase summaries, invoices, remittance advices, and other such documentation. In the absence of sufficient information to assess concerns about State MAC rates or other aspects of the State MAC program, provider requests cannot be fully considered. Providers initiating requests for review of State MAC rates or other issues may be contacted to request supporting documentation or other information.
Whom may I contact with questions regarding this initiative?
We welcome providers’ questions, comments, and input regarding the State MAC program and State MAC rate schedule. To share general comments or to request information regarding the State MAC rate schedule, you may contact the Myers and Stauffer Pharmacy Unit.
Providers are encouraged to contact the Myers and Stauffer Pharmacy Unit to discuss:
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Changes in ability to purchase drugs at or below the applicable
State MAC rate
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Changes in product availability
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Questions regarding State MAC rates
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Questions concerning drugs on the State MAC rate list
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How to obtain a copy of the State MAC rate list
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Other questions, comments, or concerns
Contact Myers and Stauffer by Telephone, Fax, Mail, or E-mail
Parties who wish to comment or discuss questions, comments, or concerns about the State MAC program may contact Myers and Stauffer weekdays between 8:00 A.M. and 5:00 P.M. (Eastern Standard Time) as follows:
Myers and Stauffer LC
Pharmacy Unit
9265 Counselors Row, Suite 200
Indianapolis, IN 46240
| Phone: 800-591-1183 |
| Fax: 317-571-8481 |
| Email: pharmacy@mslc.com |
Contact Myers and Stauffer Online
Comments or questions may be forwarded to Myers and Stauffer via the Internet at any time by visiting www.mslcwyoming.com. This Internet site has been developed exclusively to support the Wyoming Medicaid State MAC program. On this site providers will find the State MAC rate schedule and updates, news and information, and online forms to send questions and comments to Myers and Stauffer.
FAQs maintained by Myers and Stauffer, LC
Pharmacy Services.
Copyright © 2002-2006 Myers and Stauffer, LC. All rights reserved.
Revised: 02/07/06.