UnitedHealthcare Community Plan of Kansas

Maximum allowable cost (MAC) pricing information

OptumRx^® uses a variety of resources to determine the components of MAC pricing and to ensure the MAC list accurately reflects market pricing and availability of generic drugs. Various pricing factors and benchmarks are reviewed during the determination of MAC pricing.

Sources include de-identified market pricing, benchmark data including average wholesale price (AWP) and wholesale acquisition cost (WAC), wholesaler information on market availability and pharmacy information from inquiries.

The synthesis of this information helps create a market-based MAC price for generic drugs included on the MAC list. These sources are continuously monitored and updates are used to help manage market pricing fluctuations on the MAC list.

MAC lists are reviewed twice weekly with additional updates implemented on an as-needed basis based on market forces and other additional information.

If you believe a specific claim was paid incorrectly, please download this appeals form, and review the MAC appeals submissions guide for instructions.

If you have questions related to your contract with us or other issues related to the UnitedHealthcare Community Plan of Kansas Pharmacy Network, please feel free to contact our network relations line at 1-800-613-3591.

Email: pharmacycontracts@optum.com
For contracting Issues: 1-800-613-3591
Claims processing issues: 1-800-842-4195
Fax: 1-866-811-4224