Medicaid MAC Portals
Major Medicaid PBMs Now Have Online MAC Access
With the opening this week of the online MAC portal for U.S. Script, four of the six PBMs currently administering pharmacy benefits in the Texas Medicaid managed care program -- including the three most widespread PBMs -- now have online portals. Texas Health and Human Services Commission (HHSC) had extended the operational deadline for the online MAC portals required by TPBC's SB 1106 to June 1 from the original March 1, while spelling out more clearly what is expected from Managed Care Organizations to comply with the requirement.
SB 1106 by Sen. Charles Schwertner, passed during the 2013 regular session, requires each MCO in the Texas Medicaid/CHIP program to provide its network pharmacies access to its MAC list through an online portal by March 1, 2014. Compliance by many MCOs has been slow, with Navitus the only MCO or PBM to have its portal in place on or around the first of March.
As of June 10, the following PBMs have their online MAC portals in operation:
| PBM |
Service Areas |
Log-in Address |
Access Requirements |
| |
|
|
|
| Navitus |
All 10 service areas; 1 rural service area |
https://pharmacies.navitus.com/logon.aspx |
Must get new cre- dentials to access list |
| CVS Caremark |
9/10 service area; 3 rural service areas |
https://rxservices.cvscaremark.com/sign-in.aspx |
Separate registration & log-in required |
| U.S. Script |
6/10 service areas; 3 rural service areas |
https://macprice.usscript.com |
Must register for new log-in and password |
| Express Scripts |
BCBS Plan in Travis Service Area only |
www.express-scripts.com/prc |
No special proce- dures -- log in with store ID |
| Prescription Solutions |
Harris & Hidalgo Service Areas only |
N0 INFO YET |
N0 INFO YET |
|
Scott & White Prescription Services
|
Central Texas only |
N0 INFO YET |
N0 INFO YET |
Requirements for accessing the portals vary greatly. Some allow use of an existing provider ID number to log in; most require a totally separate registration and log-in to access the MAC data. Here are the PBM support documents we have at this point:
TPBC continues to work closely with HHSC to monitor compliance with the MAC portal requirement and has provided constant feedback, including reports that the portal of at least one MCO/PBM skirted the intent of SB 1106. That PBM's MAC portal allowed network pharmacists to search for the MAC price of individual drugs in the formulary, but not to access an entire MAC list as required by the legislation.
HHSC subsequently alerted MCOs that they must "at a minimum allow a network pharmacy to submit an electronic request for the MAC list on the MCO or PBM website, and the MCO or PBM must provide the requesting pharmacy with the most up-to-date MAC list electronically within 24 hours of when the request was made."
The requirement also states that a network pharmacy must be allowed to download a searchable file of the MAC list specific to that pharmacy. Alternatively, MCOs or PBMs may allow a network pharmacy to view and search the MAC list specific to that pharmacy on the website. The list must be searchable by drug name."
"We commend HHSC for taking the requirements of SB 1106 so seriously and stating clear expectations about compliance with the portal requirement," said TPBC Executive Director Michael Wright. "We now have searchable MAC files online for the most widespread Medicaid PBMs in Texas. It's incumbent on pharmacies to take advantage of this new tool and use the portals."
TPBC will continue to closely monitor development of the MAC portals and will report any new developments.