MAC list governance

Prime’s MAC List will only be made available for viewing at Prime’s corporate headquarters or another secured location designated by Prime.

Recorded reference: Page 44

Published rationale. Exhibit 7 Section 6(c) on page 44 describes the MAC Lists as Prime's proprietary databases identifying a recommended maximum allowable cost, and the definitions on page 48 say the MAC List is established by Prime and updated from time to time in accordance with the exhibit and the BPA Addendum. Employer representatives may view the list only after thirty days written request, only under Prime's non disclosure agreement, no more than four times a calendar year, and only at Prime's headquarters or another secured location. Nothing says a single list governs both what the plan pays and what pharmacies receive; on the contrary Section 6(a) on the same page has the Employer acknowledge that the Claim Administrator and Prime keep all or part of the discounts negotiated with network pharmacies. No pharmacy appeal path or timelines appear. The model requires one disclosed list with scheduled updates and appeals. This text withholds the list and permits two sided pricing, so bad.

Prime’s MAC Lists applicable to this Exhibit will be available for viewing by authorized representatives of Employer after 30 days’ prior written request submitted by Employer to Claim Administrator, and subject to Employer’s execution of Prime’s non-disclosure agreement(s).

Recorded reference: Page 44

Published rationale. On Page 44, Section 6.c allows the Employer to view Prime proprietary MAC Lists up to four times per year, upon 30 days advance written notice, subject to executing a non-disclosure agreement, and only at Prime corporate headquarters or another secured facility. The contract does not mandate a single MAC list for both plan sponsor billing and pharmacy reimbursement, nor does it establish an objective update schedule or a pharmacy appeal process with defined timelines. These onerous viewing restrictions leave MAC governance materially weaker than the model standard.

Prime’s MAC Lists applicable to this Exhibit will be available for viewing by authorized representatives of Employer after 30 days’ prior written request submitted by Employer to Claim Administrator, and subject to Employer’s execution of Prime’s non-disclosure agreement(s).

Recorded reference: Page 44

Published rationale. Page 44 calls Prime's MAC lists proprietary and permits only limited viewing after notice and a nondisclosure agreement. It also restricts request frequency and location. Page 48 defines a MAC list of unit prices updated from time to time, but does not require a schedule, a single list governing both employer charges and pharmacy reimbursement, or pharmacy appeals with deadlines. Page 44 separately says Prime pays network participants under their network contracts, while employer pricing is in an omitted addendum. This framework does not establish the model's single-list transparency and appeal system. The access restrictions are affirmative contrary provisions, even though the exact relationship between lists and actual prices cannot be tested without the addendum and network contracts.

MAC Lists applicable to this Exhibit will be available for viewing by authorized representatives of Employer after 30 days’ prior written request submitted by Employer to Claim Administrator, and subject to Employer’s execution of Prime’s non-disclosure agreement(s).

Recorded reference: Page 44

Published rationale. Page 44 says Prime owns and maintains proprietary MAC lists. The lists applicable to this exhibit may be viewed by authorized Employer representatives after thirty days written request, no more than four times a calendar year, only after the Employer signs Prime's non-disclosure agreement, and only at Prime's headquarters or another secured location Prime designates. Page 48 defines MAC as the unit price Prime sets for a multi-source drug on the list at the time of service, updated from time to time under this exhibit and the omitted BPA Addendum. The Employer pays the BPA Addendum price, Page 46, while Prime reimburses network pharmacies under the network contract, Page 44. The text does not say one MAC list governs both amounts. It does not give pharmacies an appeals path or a timeline. The model contract requires a single disclosed MAC list for plan and pharmacy payment, a stated update schedule, and a pharmacy appeals path. A view only list under a non-disclosure agreement, without appeals and without a single list rule, is present but weaker. That is partial.

Prime's MAC Lists applicable to this Exhibit will be available for viewing by authorized representatives of Employer after 30 days' prior written request submitted by Employer to Claim Administrator

Recorded reference: Page 44

Published rationale. The model term wants a single MAC list governing both what the plan pays and what pharmacies are paid, disclosed, updated on a schedule, with a pharmacy appeals path. Exhibit 7 section 6(c) on page 44 does give the Employer access to Prime's MAC lists, but the access is nominal: 30 days advance written request, execution of Prime's non-disclosure agreements, no more than four requests per calendar year, and viewing only at Prime's headquarters or another secured location it designates. Definition 19 on page 48 says the list is maintained by Prime and updated from time to time, not on a disclosed schedule. Nothing states that the plan side and pharmacy side lists are the same, which leaves the classic two list spread mechanism open, and no pharmacy appeal process with timelines appears anywhere. A disclosed but caged list with no appeals and no single list rule is materially weaker than the model.