The APCI Choice team has learned that members are seeing positive results when submitting manual MAC appeals to the following PBMs. The following tips are intended, when possible, to produce positive increases to losses incurred when adjudicating a generic prescription that was reimbursed at MAC reimbursement rate:

Express Scripts Portal: 

Pharmacist Resource Center | FAQs - After logging into the ESI portal, across the blue ribbon at the top, choose APPEALS and fill in the required info. This process is very straightforward and easy to do. You MUST submit an invoice showing your latest acquisition cost; again, the instructions are very clear on how to do this. Redact EVERYTHING on the invoice except for what is required.

CVS Caremark Portal:

Sign In - After logging into CVS Caremark portal, across the black ribbon at the top, choose APPEALS MENU and then submit appeal. This process is very straightforward and easy to do. You MUST submit an invoice showing your latest acquisition cost; again, the instructions are very clear on how to do this. Redact EVERYTHING on the invoice except for what is required.

As a reminder, Health Mart Atlas (HMA) submits eligible MAC appeal claims to the following list of PBMs: