MAC Pricing

What is MAC prescription pricing and how can it benefit my long-term care facility?

MAC Rx pricing is a state Medicaid based pricing model

A maximum allowable cost (MAC or SMAC) pricing model is set by a state Medicaid system to ensure the state pays a prudent price for generic medications. In turn, MAC Rx charges this state Medicaid based pricing model to its customer facilities. This ensures that your facility is essentially paying the same pricing as Medicaid, with savings in the 13% – 28% range versus other long-term care pharmacies. (Savings is estimated off your total spend.)

MAC Rx provides its customers with the state based Medicaid equivalent pricing for your facility cost exposure of Medicare Part A and managed care stays. The state maximum allowable cost (MAC or SMAC) is the maximum amount per generic medication eligible for reimbursement paid by a state Medicaid directly to pharmacies. With MAC Rx, the facility is essentially then paying the pharmacy the very same price that the state pays the pharmacy directly – state Medicaid based pricing!

MAC Rx and Medicare Part A stays

MAC Rx works with facilities to discharge residents with medications for continuity of care and to ensure they do not spend time trying to fill prescriptions in a retail setting after discharge. With appropriate documentation, MAC Rx bills the facility for only what was consumed on a Medicare Part A/Managed Care stay. The remainder of the dispense is billed directly to the resident. This split billing process ensures reduction of cost to the facility but also ensures continuity of care for the discharged resident and their caregivers. 

MAC Rx pricing saves our customers an average of 13% - 28%.

How to calculate MAC pricing

Healthcare costs continue to rise. With MAC Rx, your facility can start saving on all prescriptions while gaining a pharmacy and nursing partner to assist your internal team, manage costs and enhance resident care.

We charge each facility the state-based pharmacy reimbursement for medications, also called the MAC or SMAC reimbursement. These charges are transparent and auditable, and may be found in detail here. To determine the cost, simply find the individual generic medication and take it times the quantity, and add $5.50 for generic medications.

MAC Rx also utilizes the state Medicaid reimbursement-based model for single-source drugs using the wholesale acquisition cost (WAC) based formula. MAC Rx always dispenses the generic alternative when available for a brand medication when there is no dispense as written (DAW) order.

Please contact MAC Rx today for a no-cost, apples to apples “cost-out” evaluation of your current pharmacy charges versus MAC Rx. With over 110 previous “cost-outs,” we are confident the savings will be in the 13% – 28% range!

How to start saving now with MAC Rx

MAC Rx pricing saves our customers an average of 13%-28% with the lowest state-Medicaid based pricing. Many factors affect this amount, especially when considering brand to generic mix within a particular facility. As a long-term healthcare facility, if you are not receiving MAC pricing, you must consider this thought. Why should you pay more than the state for generic medications?
MAC Rx pricing will offer substantial savings to your facility.
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Are you ready to request a free, no obligation cost comparison?

Call CEO Curt Ayers
 at 224-220-2700 ext. 101.