Submission Of A Mac Appeal

A. Submission requirements. A MAC appeal submission include: (1) fill date; (2) BIN number (six digits); (3) NCPDP (seven digits); (4) Rx number; (5) NDC 11 (11 digits); (6) drug name; (7) drug strength; (8) invoice price and net purchase price of drug (whole dollar with two decimal places); (9) total reimbursement (whole dollar with two decimal places); (10) reason for review; (11) any information required by contract; and (12) notes (optional). B. No additional information required. A PBM shall not require or request additional information to process a MAC appeal but shall accept and consider any additional information provided in a MAC appeal submission.