Myers & Stauffer LC

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 Idaho 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 Idaho Medicaid pharmacy providers for selected drug products. 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.

Why should I send information about my pharmacy’s drug purchases to Idaho Medicaid, if requested to do so?

The State MAC rate schedule is based on Idaho 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. It is to your benefit to provide the requested information to insure that the established State MAC rates fully consider your pharmacy’s cost experience in the marketplace.

As of April 1, 2010, pharmacies enrolled in the Idaho Medicaid program are required under House Bill 708 Section 5, 56-209g to participate in periodic cost surveys by disclosing the costs of all drugs net of any special discounts or allowances. Also, the provider agreement you entered into with Idaho Medicaid includes as a condition of participation in Medicaid, a requirement that you comply with all applicable provisions of State law. Failure to participate in the survey will be viewed as non-compliance with the Medicaid Provider Agreement as well as State law.

What will Idaho Medicaid do with drug purchase information it receives from me?

DHW will use any drug purchase information submitted by pharmacies exclusively for the purpose of establishing, evaluating, maintaining, and updating a State MAC rate schedule for the Idaho Medicaid program. As mentioned above, the DHW has contracted with the firm of Myers and Stauffer to assist in developing and maintaining the State MAC. In accordance with the terms of Myers and Stauffer’s contract with the State of Idaho, all information will be maintained confidentially and will not be shared with parties external to the Idaho Medicaid program without appropriate authorization. Pharmacies are strongly encouraged to submit copies of purchase information, rather than originals, as information submitted will not be returned.

Why might my pharmacy be selected to provide drug purchase information?

All pharmacy providers enrolled in the Idaho Medicaid program are eligible for random selection to provide drug purchase information to DHW and Myers and Stauffer.

How often might I be asked to provide drug purchase information?

All pharmacy providers enrolled in the Idaho 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 one to two times per year.

What is the Idaho Medicaid program’s authority to request and review my drug purchasing records and associated information?

How will the State MAC rate schedule be updated? How do I report concerns about product prices or product availability?

DHW recognizes that changes in pharmaceutical prices and product availability occur on a regular basis. In addition, DHW recognizes that the most current, and reliable information regarding changes in acquisition cost and product availability will be provided by the pharmacies. DHW will obtain and review industry data, such as published pricing information, and information provided by Idaho 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 DHW review State MAC prices for particular drugs. Providers who wish DHW to consider adjustments to State MAC rates or other concerns about the State MAC program may make such a request by contacting DHW or Myers and Stauffer in writing by e-mail or regular mail. When making such a request, providers will be asked to provide as much information as possible to assist DHW 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 general 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:

    ·    Changes in ability to purchase drugs at or below the applicable State MAC rate
    ·    Changes in product availability
    ·    Questions regarding State MAC rates
    ·    Questions concerning drugs on the State MAC rate list
    ·    How to obtain a copy of the State MAC rate list
    ·    Other questions, comments, or concerns

Contact Myers and Stauffer by Telephone, Fax, or 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. (Mountain Standard Time) as follows:

Myers and Stauffer LC
Pharmacy Unit
9265 Counselors Row, Suite 200
Indianapolis, Indiana 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 http://id.mslc.com. This Internet site has been developed exclusively to support the Idaho Medicaid State MAC program. On the site providers may find the State MAC rate schedule and updates, news and information, and online forms to send questions and comments to DHW or Myers and Stauffer. All information submitted via the site will be forwarded directly to Myers and Stauffer. Within 24 hours, staff from Myers and Stauffer will respond by telephone.

FAQs maintained by Myers and Stauffer, LC Pharmacy Services.