MAC pricing and Negative Margin Issue

Started by kvl1027
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kvl1027

kvl1027

Member
15+ Year Member
I'm just calling out to my fellow Indie to find out how you are dealing with, what seems to be, a growing problem. I am talking about these insurance companies that are now reimbursing based on MAC pricing, and saying "screw what you pay for it" How are we going to stay afloat when we are getting reimbursed less than cost?
 
Hello

I am currently doing a managed care residency and coincedentally just did a MAC pricing over view today. Before an insurance companie decides on a price to MAC a product, they do research to see what all generic companies are offering for that drug. Insurance companies atleast mind never MAC with the least price. They always chose the avarage. For example if KCL is sold by 3 different manufacturers at 5 cents, 25 cents and 40 cents. We will MAC at 25 cents. The onus is for the pharmacy to go out there and shop better. I know independence are limited due to the fact that they deal only with one wholesaler as oppose to large chains who have options like mckesson, cardinal and many other optionsetc

Hope this helps
 
she2006 said:
Hello

I am currently doing a managed care residency and coincedentally just did a MAC pricing over view today. Before an insurance companie decides on a price to MAC a product, they do research to see what all generic companies are offering for that drug. Insurance companies atleast mind never MAC with the least price. They always chose the avarage. For example if KCL is sold by 3 different manufacturers at 5 cents, 25 cents and 40 cents. We will MAC at 25 cents. The onus is for the pharmacy to go out there and shop better. I know independence are limited due to the fact that they deal only with one wholesaler as oppose to large chains who have options like mckesson, cardinal and many other optionsetc

Hope this helps
Click to expand...

We use two different wholesalers and we usually go with the cheapest option and we still get burned sometimes. Nothing more than an attempt to squash out small business I guess. I just don't know how they can get away with reimbursing based off of the manufacturer's pricing. Pharmacies purchase drugs from wholesalers, so we should be reimbursed based on the price "we" can get it for.
I have some medications that are -$80 and up, I don't think it would matter what distributor you went with, I can't imagine the prices to be that far off. A sad commentary I guess.
 
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