MAC Appeals & Specific State Requirements

MAC Appeals

Integrated Prescription Management, Inc. (IPM) has established a standard process for contracted pharmacies, pharmacy services administration organizations (PSAO), and group purchasing organizations (GPO) (“appealing party”) to submit Maximum Allowable Cost (MAC) pricing appeals to IPM for consideration of a MAC adjustment.  MAC appeals will be reviewed in accordance with IPM’s standard MAC appeal process unless otherwise required by state law as outlined below.  The IPM standard MAC Appeal Form is provided in a fillable PDF or Excel format.

IPM’s standard process allows pharmacies to submit an appeal within 60 calendar days from the date of service. IPM will review the appeal and provide a determination within 10 calendar days of receipt of a valid MAC appeal.  Determinations will be sent via secure email or facsimile to the appealing party.  For determinations decided in favor for the pharmacy, the pharmacy will have 60 calendar days to resubmit the claim for an adjustment.

State Specific Requirements

Click on the links below for state specific requirements.