MAC

​We are committed to ensuring compliance with all state legislative and regulatory requirements related to the provision of pharmacy and ancillary services. To assure the Maximum Allowable Cost (MAC) list accurately reflects market pricing and the availability of generic drugs, Optum utilizes multiple sources to determine MAC pricing. The sources include de-identified market pricing benchmark data such as AWP and WAC, wholesaler information on market availability and pharmacy information from inquiries. A synthesis of these and other sources helps create a market based MAC price for generic drugs on the MAC list.

The following states have passed legislation requiring workers’ compensation pharmacy benefit managers (PBMs) to provide a process for pharmacies to make an inquiry about MAC pricing for a specific medication and to provide for an appeals process: Arkansas, Colorado, Georgia, Hawaii, Kentucky, Maine, New York, Oregon, Vermont, and Washington.

  • If you are a pharmacy who would like to receive information regarding our MAC pricing for a specific medication, please complete the MAC Inquiry form, along with a signed non-disclosure agreement and email the documents to MACresolution@optum.com.
  • If you are a pharmacy who would like to file an appeal or otherwise dispute our MAC pricing for a specific medication, please complete the MAC Dispute form along with a signed non-disclosure agreement and email the documents to MACresolution@optum.com.
In accordance with requirements established by the states of Arkansas​, Georgia, New York and Washington, the below telephone number is available for questions regarding MAC pricing:
  • (855) 264-8815.
Links to the MAC Inquiry Form and MAC Dispute Form are located at the bottom of this page, as is a Non-Disclosure Agreement. If you have general questions regarding our MAC pricing, please email us at MACresolution@optum.com.

Forms

MAC Inquiry             MAC Dispute             Non-Disclosure Agreement