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FRANKFORT, Ky. — Kentucky on Friday became the first state to enact legislation that provides pharmacists with transparency into how health plans determine pharmacy reimbursements for generic drugs, and establishes an appeals process when a dispute arises over those payment levels.
Specifically, the new law creates a set of standards with relation to categorizations and formularies for how pharmacy benefit managers craft their MAC lists, requires more frequent updates and streamlines the process for pharmacy reimbursement appeals.
"This transparency legislation will simply let pharmacists know how individual health plans will calculate a pharmacy's reimbursement, and require timely updates to those rates to reflect market prices," noted Douglas Hoey, CEO for the National Community Pharmacists Association, which had lobbied for the bill. "With that information a small business community pharmacy owner can better evaluate contract proposals and determine whether they make business sense to accept. That, in turn, will benefit Kentucky patients and the state's economy," he said.
"We hope Kentucky's common-sense MAC reform serves as a model for the nation as similar legislation is being considered across the country, Hoey concluded"