The statute mandates that there must be a process for contracted pharmacies to appeal and resolve disputes regarding the MAC pricing. The right to appeal is limited to sixty days following the initial claim, but the PBM must resolve the issue within 10 days. Creates enhanced limitations on the types of drugs that can be placed on a MAC list and requires the PBM to disclose the identity of the drugs on the MAC list as well as the sources used to create the prices.

Link to Existing Law: KRS 304.17 A-162

This is one of the more robust MAC laws. The timeframe to submit an appeal is significantly longer than other states. Interestingly, explicitly allows for PSAOs and GPOs (in addition to contracted pharmacies) to appeal and resolve disputes regarding the MAC pricing. In addition, if an appeal is denied, the PBM must provide the pharmacy the reason for the denial as well as the NDC of an equivalent drug that may be purchased by a similarly situated pharmacy at the price that is equal to or less than the maximum allowable cost of the appealed drug. However, given the appeal can only be made to the PBM, there is opportunity to advocate for a stronger regulatory scheme and oversight of PBM.