Required PBMs utilizing MAC lists to use comparable drug prices obtained from multiple nationally recognized comprehensive data sources including wholesalers, prescription drug file vendors, and pharmaceutical manufacturers for prescription drugs that are nationally available and available for purchase locally by multiple pharmacies in the state. In instances when MAC pricing applies, a PBM must provide a pharmacy information regarding which of the national compendia is used to obtain pricing data used in the calculation of the MAC price and shall provide a process to allow a pharmacy to comment on, contest, or appeal the MAC rates or MAC list. The right to comment on, contest, or appeal the MAC rates or MAC list must also allow for retroactive payment in the event that it is determined that MAC pricing has been applied incorrectly.

Link to Existing Law: I.C.A. § 510B.8

This law is a model MAC law which includes state regulatory oversight who could require the PBM to submit information to the Commissioner regarding the PBM’s pricing methodology for the maximum reimbursement amount. However, it was previously held to be preempted by PCMA v. Gerhart (8th Cir. 2017). See also Arkansas above. However, with the recent SCOTUS ruling in the Rutledge case, there is a strong basis to believe that this law is now enforceable and not preempted under ERISA although some additional time is necessary to let the implications of the Rutledge ruling play out‐‐this is a law we will monitor.