Maximum Allowable Cost pricing
Under Maximum Allowable Cost (MAC) pricing, only the MAC priced drugs which are the designated lowest-cost drugs, will be covered by Alberta government-sponsored drug programs. Within each category of MAC products there are a variety of drugs available, clinical evidence shows that all of them are therapeutically similar and equally effective.
Physicians may continue to prescribe and plan members may continue to choose any brand name or generic product; however, the Alberta government sponsored drug programs will only pay up to the MAC price and the plan member will be responsible for paying the difference.
If plan members are currently taking a medication that costs more than the MAC price, they can ask their pharmacist to adapt their prescription for the MAC-priced drug.
If a plan member has tried the MAC priced drug, and experienced a documented intolerance, their physician can request an exception by submitting a pricing authorization request form to Alberta Blue Cross®.
MAC pricing is an approach that defines the maximum amount a plan will pay for the cost of a drug product within a specific grouping of drugs used to treat a common condition. For drugs that have a cost at or below the maximum, there will be no effect on how they are covered by a plan. For drugs that have a cost above the maximum, the plan will only pay up to the maximum amount and the plan member will be responsible for the difference in cost.
MAC pricing is an approach that defines the maximum amount a plan will pay for the cost of a drug product within a specific grouping of drugs used to treat a common condition. For drugs that have a cost at or below the maximum, there will be no effect on how they are covered by a plan. For drugs that have a cost above the maximum, the plan will only pay up to the maximum amount and the plan member will be responsible for the difference in cost.
This program applies to all Alberta government-sponsored plans including Group 1, Group 66, Palliative Care and Alberta Human Services.
MAC pricing applies to several drug categories shown here.
Plan members will need to obtain the drug identification number (DIN) for the drug they are inquiring about; then, they can sign in to the Alberta Blue Cross® member website and look up the drug in question. If MAC pricing applies to their drug, information will be available on the site. They can also call Alberta Blue Cross® Customer Services or speak to their pharmacist for more information.
If plan members are prescribed a drug that is at or below the MAC price, they do not need to pay additional costs. If they are prescribed a drug that is above the MAC price, they have two options:
- Talk to their physician or pharmacist about changing their prescription to a drug that is at or below the MAC price.
- Pay the difference out-of-pocket if they choose to continue on their current medication.
Yes; a pharmacist can adapt the prescription to another product within the MAC grouping when appropriate.
They will need to speak with their physician or pharmacist for more information. If a plan member experiences a severe allergic reaction to rabeprazole or pantoprazole magnesium, their prescriber can request an exception by submitting a special authorization request form to Alberta Blue Cross®.
Plan members can contact their physician or pharmacist for more information. Information about this topic is available on the Alberta Health website.