As part of his ongoing effort to improve prescription drug programs, Congressman Doug Collins (GA-09) re-introduced the MAC Transparency Act, H.R. 224, in his first week of the 114th Congress. This legislation was previously introduced in the 113th Congress as H.R. 5815. Congressman Dave Loebsack (IA-02) joined Rep. Collins in reintroducing the legislation, vitally important to improving fairness and transparency in reimbursements to independent and community pharmacists.
"Local pharmacies in rural Northeast Georgia are the first place we turn when our loved ones fall ill. They are the backbone of our healthcare system, beloved in our communities, especially among seniors," said Rep. Collins. "But they are under attack. My bill stops Medicare and other federal programs from favoring large competitors with more resources to untangle confusing federal programs."
Maximum Allowable Cost (MAC) lists set the maximum amount a Pharmacy Benefits Manager (PBM) will reimburse a pharmacy for generic drugs. Because PBMs often consult differing lists, pharmacies of every size and affiliation face uncertainty about what generic drugs Medicare or other federal programs will cover and at what price. As a result, independent and community pharmacies operate in the dark under "take-it-or-leave-it" contracts that are creating financial hardship and threatening their very existence.
Rep. Collins' bill clarifies how MAC lists are determined, how frequently PBMs must update them, and the appeals process for pharmacies to dispute reimbursements. H.R. 224 expands these important reforms to Medicare Part D, TRICARE, and the Federal Employees Health Benefits Program.
Significantly for community and independent pharmacies, the MAC Transparency Act would compel federal programs to disclose unfair practices, for instance, a PBM using one list to reimburse contracted pharmacies but another to sell drugs to clients of plan sponsors.