To be on the MAC list a drug must have an “A” or “B” rating in the most recent version of the Orange Book; or is rated “NR” or “NA” or has a similar rating by a nationally recognized reference; and is generally available for purchase by pharmacists and pharmacies in this state from a national or regional wholesaler; and is not obsolete. The PBM must review the list every 7 days to reflect any modifications. The PBM must establish an appeals process and must respond to a challenge not less than the 15th day after the date the challenge is made. If the challenge is successful, the PBM must make an adjustment to all similarly situated pharmacies that day and if denied, the reason for denial. Additionally, the PBM must report to the commission every 90 days the total number of challenges that were made and denied. PBMs must notify the commission no later than the 21st day after implementing a MAC list for drugs dispensed at retail but not by mail and must provide a process for network pharmacies to access the MAC list.

Link to Existing Law: Chapter 1369, Insurance Code, Section 1369.353

This is a fairly standard MAC law, but uniquely, calls for enhanced reporting to the State Insurance Commissioner, including the number of appealed MAC prices.