Specifications include, but are not limited to:STATE is soliciting proposals for an entity to develop and maintain a pharmacy MAC list for drug payment rates. The successful offeror must understand North Dakota’s unique situation for pharmacy ownership and the MAC list supplied will reflect that understanding. The successful offeror also will compare its list to the FULs and utilize STATE’s claims data to ensure that STATE pays less, in the aggregate, by using STATE’s MAC list than by using the FULs. The successful offeror will provide STATE with a market appropriate MAC list weekly. STATE anticipates that the successful offeror will survey pharmacies and wholesalers to determine acquisition costs for pharmacies in North Dakota and will apply a market appropriate calculation to those numbers to ensure the MAC is set at levels that will not discourage participation in North Dakota Medicaid. The successful offeror shall respond to market changes (new generics, increased generic competition, generic manufacturer withdrawal from the market, etc.) and shall provide appropriate and timely MAC list adjustments. The MAC list must be broad and must include both prescription and over-the-counter medications as well as injectable and specialty medications. The MAC list only needs to include products covered by STATE and does not need to include products that are not covered (e.g. many of over-the-counter medications as only a few are covered). STATE will work with the successful offeror routinely to identify items for inclusion or deletion from the MAC list. This may result in additions to or changes in the MAC list outside of the agreed to monthly basis. The successful offeror will respond on the same business day to STATE or a North Dakota Medicaid Provider inquiry regarding MAC rate concerns; the successful offeror shall provide STATE or a North Dakota Medicaid Provider with National Drug Codes (NDCs) for products that are available for purchase from wholesalers at a price below the MAC rate to resolve these concerns, or shall propose a new MAC rate for that product. The successful offeror shall supply STATE with a routine update file providing MAC updates. The file must include effective dates for the pricing change, drug name, strength, form (e.g. tablet), new MAC price, and First Data Bank Generic Code Numbers (GCNs) and GCN Sequence Numbers (GSNs) or NDC if the MAC will be applied at an NDC level. The successful offeror shall supply STATE with a routine full MAC list, which will include the same data fields as the update file. The successful offeror shall compare its MAC list to the FULs and utilize claims data provided by STATE to run calculations on a routine basis to ensure that STATE is paying less, in the aggregate, than if it were to use the FULs. These calculations will include only medications on the FUL list. For instance, savings from a medication not included on the FUL list cannot be used as savings generated as the ‘in the aggregate’ calculation only applies to FUL medications. STATE expects the successful offeror’s MAC list to include more medications than the FUL list and not be restricted to only products with generics. For instance, hemophilia factors currently have MACs but they do not have generics.
