Maximum Allowable Cost (MAC) Appeals

Are you filing prescriptions for patients in Tennessee and getting paid BELOW your acquisition cost?
Are you having to refer patients to other pharmacies because you can't afford to stock prescription products that are reimbursed below your cost?
What if you could increase your reimbursement by $30,000-$40,000/year?
Tennessee is one of the only states in the country that mandates pharmacies be reimbursed at least the cost of the prescription!

MAC Appeals in Tennessee (Rule 0780-01-95)

Don't lose money! At least break even.

Tennessee pharmacies can appeal third party payors for negative reimbursed claims to be paid at least the acquisition cost of the drug. These claims are specifically for commercial plans operating in Tennessee.

How Much Money?

Depending on the volume of prescriptions and payor mix, we estimate MAC appeals could increase reimbursement by $500 - $1,000/week.

Keep Your Patients

MAC appeals can prevent you from having to transfer patients to other pharmacies and maintain prescription volum

Access a Tutorial Training to Learn how to do MAC Appeals

MAC appeals are not complicated!
Pharmacy benefit managers (PBM) have different processes and requirements for submission of claims.
TN Rx Law Review has developed an educational training on how to file and reconcile MAC appeals for Caremark, ExpressScripts, and OptumRx.
The training provides a walk-thru video tutorial (including slides) on how to submit for each platform. It also details how to format a tracking file to maintain records of your appeals.
Anticipated return on investment within 1 month of purchasing educational tutorial!
Purchase the MAC Appeal Tutorial to access the training