Dispute Resolution ProcessThe intent of the MAC (maximum allowable cost) program is to reimburse providers fairly based on accurate generic drug costs. If a provider discovers that the MAC price does not accurately reflect the drug cost, the provider should explore alternative manufacturers or wholesalers that more accurately reflect the MAC price. If there are no manufacturers or wholesalers that are at or below the established MAC price, the providers may request a review for resolution.
The providers may call 1-866-312-8467, or fax the designated form to 1-866-312-8470 or e-mail email@example.com. with dispute resolution requests with the proper information; NDC, drug name, strength and dosage form, manufacturer, package size, wholesaler, lowest price found and search date. All the information will be researched and the appropriate action taken.
Providers will be notified of the receipt of their dispute resolution request within one business day. A resolution and notification to the provider will take place within three business days. The providers will either receive a notice stating that there has been confirmation of alternative manufacturers or wholesalers who have the product available at or below the MAC price, or the MAC price will be adjusted accordingly to reflect the collected data. The revised price will be effective from the date of the request. Providers may reverse and resubmit all affected claims made from the effective date forward. The MAC list will be updated monthly and can be found and downloaded from our website at www.dmas.virginia.gov.