FAQs
What is a State Maximum Allowable Cost (State MAC) rate schedule?
Why might Alabama Medicaid request information about my pharmacy’s drug purchases?
Why should I send information about my pharmacy’s drug purchases to Alabama Medicaid, if requested to do so?
What are the acceptable methods to transmit my drug purchase information?
What will Alabama Medicaid do with drug purchase information it receives from me?
Why might my pharmacy be selected to provide drug purchase information?
How often might I be asked to provide drug purchase information?
For what time period would my drug purchase information be requested?
How will the State MAC rate schedule be updated? How do I report concerns about product prices or product availability?
How often will the State MAC rate schedule on the Myers and Stauffer Alabama Pharmacy Web site be updated?
Whom may I contact with questions regarding this initiative?
What is a State Maximum Allowable Cost (State MAC) rate schedule?
State Maximum Allowable Cost (State MAC) rate schedules are based on the premise that chemically equivalent drug products in the same strength and dosage should be reimbursed similarly. State MAC rates are designed to maximize the cost-effectiveness of pharmacy services by setting reimbursement amounts for therapeutically equivalent drug products at the same price, based on the cost of the products. The Centers for Medicare and Medicaid Services (CMS) uses this same premise to establish federal upper limits (FULs) for drug products. State MAC rates are essentially the state Medicaid program version of CMS FULs
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Why might Alabama Medicaid request information about my pharmacy’s drug purchases?
In order to maintain a State MAC program with reimbursement that reflects current pharmaceutical market conditions, the State MAC rate schedule is based on the actual acquisition costs of Medicaid pharmacy providers. The calculated rates are designed to reimburse ingredient costs, considering the prices pharmacies must pay in order to acquire the selected drugs and pharmacies' need for flexibility in the acquisition of proper drugs to fill prescriptions.
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Why should I send information about my pharmacy’s drug purchases to Alabama Medicaid, if requested to do so?
The State MAC rate schedule is based on Medicaid pharmacy providers’ actual experiences purchasing selected drug products. Individual providers’ ability to purchase drug products at or below the established State MAC rates will be contingent on representation in the purchase information the Medicaid Agency (ALMA) uses to establish and maintain the State MAC rate schedule. Providers who receive requests for drug purchase information are required by ALMA to provide the requested information to insure that the established State MAC rates fully consider providers' cost experience in the marketplace.
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What are the acceptable methods to transmit my drug purchase information?
For drug purchases made during the identified time period requested by the Alabama Medicaid Agency (ALMA), providers can simply retrieve the invoices reflecting their purchases, photocopy the records, then mail the copies to Myers and Stauffer. A provider can also provide this data via email in an electronic format. Electronic files can be accepted in Excel format, or as tab-delimited or pipe-delimited text files. The following outlines the electronic file layout:
| Field |
Data Type |
Length |
| Pharmacy_ID |
Text |
15 characters, variable length |
| Pharmacy_Name |
Text |
100 characters, variable length |
| Invoice_Date |
Date |
10 characters (mm/dd/yyyy) |
| MDC_CODE |
Text |
11 characters, fixed length |
| Item_Number |
Text |
10 characters, variable length |
| Item_Description |
Text |
100 characters, variable length |
| Package_Size |
Text |
75 characters, variable length |
| Net_Quantity |
Integer |
Whole number (15 digits, no decimals) |
| Unit_Of_Measure |
Text |
25 characters, variable length |
| Unit_Cost |
Decimal |
0000000000000000.00000 (15 digits, 5 decimal places) |
| Net_Extended_Cost |
Decimal |
0000000000000000.00000 (15 digits, 5 decimal places) |
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What will Alabama Medicaid do with drug purchase information it receives from me?
The ALMA will use drug purchase information submitted by pharmacies for the purpose of establishing, evaluating, maintaining, and updating a State MAC rate schedule. The ALMA has contracted with the firm of Myers and Stauffer to assist in developing and maintaining the State MAC. Pharmacies are encouraged to submit copies of purchase information, rather than originals as information submitted will not be returned.
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Why might my pharmacy be selected to provide drug purchase information?
All pharmacy providers enrolled in the Alabama Medicaid Agency program are eligible for random selection to provide drug purchase information to the ALMA and Myers and Stauffer.
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How often might I be asked to provide drug purchase information?
All pharmacy providers enrolled in the Alabama Medicaid program are eligible for selection to provide drug purchase information. Periodically, Myers and Stauffer will request purchase information from a sample of identified pharmacy providers. It is not anticipated that any pharmacy location will be selected more frequently than once every two years.
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For what time period would my drug purchase information be requested?
All pharmacy providers enrolled in the Alabama Medicaid program are eligible for selection to provide drug purchase information. When a request is received for drug purchase information, the time frame of the data will be requested for the most recent 30 day period. If that drug purchase information for the most recent 30 day period is not readily available, then the next most recent 30 day period will be acceptable.
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How will the State MAC rate schedule be updated? How do I report concerns about product prices or product availability?
The Alabama Medicaid Agency (ALMA) recognizes that changes in pharmaceutical prices and product availability occur on a regular basis. In addition, the ALMA recognizes that the most current, and reliable information regarding changes in acquisition cost and product availability will be provided by pharmacies. The ALMA will obtain and review industry data, such as published pricing information, and information provided by Alabama pharmacies to frequently assess the State MAC program and to insure that State MAC rates reflect current pharmaceutical market conditions. To respond to changes in the pharmaceutical market that may impact the price and/or availability of drug products, adjustments to the State MAC program will be made periodically as needed.
Providers may also request that the ALMA review State MAC prices for particular drugs. Providers who wish the ALMA to consider adjustments to State MAC rates may make such a request by contacting Myers and Stauffer in writing by e-mail, regular mail, fax or toll free telephone. When making such a request, providers will be asked to provide as much information as possible to assist the ALMA and Myers and Stauffer in understanding the specific issue being raised and the provider’s desired outcome. Helpful information should include but not be limited to drug purchase summaries, invoices, remittance advices, and other such documentation. In the absence of sufficient information to assess concerns about State MAC rates or other aspects of the State MAC program, provider requests cannot be fully considered. Providers initiating requests for review of State MAC rates or other issues may be contacted to request supporting documentation or other information.
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How often will the State MAC rate schedule on the Myers and Stauffer Alabama Pharmacy Web site be updated?
The State MAC rate schedule will be updated as necessary as changes are made to the State MAC rates for any drug. The updated State MAC rate schedule will be posted along with the effective date of the change.
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Whom may I contact with questions regarding this initiative?
We welcome provider's questions, comments, and input regarding the State MAC program and State MAC rate schedule. To share general comments or to request information regarding the State MAC rate schedule, you may contact the Myers and Stauffer Pharmacy Unit.
Providers are encouraged to contact the Myers and Stauffer Pharmacy Unit to discuss:
· Changes in ability to purchase drugs at or below the applicable State MAC rate
· Changes in product availability
· Questions regarding State MAC rates
· Questions concerning drugs on the State MAC rate list
· Questions concerning drugs on the State MAC rate list
· How to obtain a copy of the State MAC rate list
Contact Myers and Stauffer by Telephone, Fax, Mail, or E-mail
Parties who wish to comment or discuss questions, comments, or concerns about the State MAC program may contact Myers and Stauffer weekdays between 8:00 A.M. and 5:00 P.M. (Central Time) as follows:
Myers and Stauffer LC
Pharmacy Unit
9265 Counselors Row, Suite 200
Indianapolis, IN 46240
Phone: 800-591-1183
Fax: 317-571-8481
Email: pharmacy@mslc.com
Contact Myers and Stauffer Online
Comments or questions may be forwarded to Myers and Stauffer via the Internet at any time by visiting al.mslc.com. This Internet site has been developed exclusively to support the Alabama Medicaid State MAC program. On this site providers will find the State MAC rate schedule and updates, news and information, and online forms to send questions and comments to Myers and Stauffer.
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FAQs maintained by Myers and Stauffer, LC Pharmacy Services.
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