On June 25, 2015 the California Assembly passed AB 627, a Bill by Assembly member Jimmy Gomez and sponsored by the California Pharmacists Association. The Bill is the “MAC Transparency Bill” and was introduced to establish fair standards for MAC-based pharmacy reimbursement.


AB 627 requires PBMs to update their Maximum Allowable Cost (MAC) lists weekly; requires PBMs to provide in-network pharmacies with the current MAC list upon request and disclose the sources used in establishing MAC lists; and establishes much-needed standards for appeals filed by pharmacies for MAC list prices that appear to be out of date.  Independent community pharmacies should not have to dispense medications to their patients at a financial loss and pharmacists’ time should not be taken away from caring for patients in order to appeal negative reimbursements.


Pharmacies purchase prescription drugs and pay up front. When a patient with health coverage receives a drug, the health plan or insurer-or a contracted pharmacy benefit manager (PBM)-reimburses the pharmacy for the cost of the drug. Most health plans and PBMs reimburse pharmacies for generic drugs based on proprietary price lists known as MAC lists. PBMs establish these MAC lists based on national and regional drug pricing data in an attempt to reimburse pharmacies as close as possible to the current market rate for drugs.  However, drug prices fluctuate on a daily basis; sometimes they go up in price, other times they go down in price. If a drug goes up in price, the pharmacy pays that higher price.  If a PBM does not update its MAC list on a regular basis, the pharmacy may be reimbursed significantly less for a drug than they paid to acquire it-sometimes hundreds of dollars less.  For drugs that see a steep price increase and no MAC price update from a PBM, pharmacies sometimes stop purchasing the drugs altogether otherwise they stand to lose thousands of dollars.  The end result is that it can become difficult for patients to obtain certain prescription drugs.[1]


AB 627 has been sent to Governor Jerry Brown and is awaiting his action within the next few days. This Bill is VERY IMPORTANT to pharmacists in California and could set a precedent for other Sates to follow and even legislation at the Federal Level.


Please go to this link ASAP and send a message to Governor Brown in support of the bill.


You can see the complete bill by clicking HERE (AB627)


[1] From CPhA website https://www.votervoice.net/CPHA/campaigns/41659/respond?utm_source=Capitol+Pulse+-+6.30.15&utm_campaign=CAP+Pulse&utm_medium=email