Maximal Allowable Cost (MAC) Program

The Maximum Allowable Cost (MAC) pricing program limits the amount paid by the government of Alberta for publicly funded drug plans.

Currently ACE inhibitors, ARBs, CCBs, statins and PPIs are subject to MAC pricing.

The coverage of drugs under MAC pricing is not impacted, but the amount the government pays for those drugs is. Within each class, a reference drug is chosen as the Maximum Allowable Cost drug.

The government will pay the cost of the drug OR the cost of the MAC drug, whichever is lower. The difference between the actual cost of the drug and the amount paid by the government will be paid out of pocket by the patient.

A quick example: Tony takes perindopril 8mg once daily. The reference drug for ACE inhibitors is lisinopril 20mg. 100 days of perindopril would cost $43.35 whereas lisinopril would be $33.59. The government will only cover the portion of the price up to the MAC price. In this case, the difference to which the patient would pay would be $9.76.

We encourage prescribers to consider costs (and medication coverage) when treating chronic medical conditions and especially when choosing between therapeutically similar medications. In addition to considering lowest cost alternatives, other ways of decreasing drug costs include:

  • Prescribing products priced at or lower than MAC products (see below)
  • Using combination products
  • Extending long term prescriptions to 100 days
  • Splitting medications, if possible

Specific examples of where prescribing can substantially decrease unnecessary pharmaceutical spending without negative patient outcomes includes:

  • PPIs: Use MAC PPI (pantoprazole magnesium) when possible
  • ACE inhibitors: Change to MAC ACE inhibitors when possible (ramipril or lisinopril)
  • Biosimilars: Use biosimilars when possible
  • Anti-VEGFs for macular degeneration: Bevacizumab as effective and less expensive than alternatives
  • DPP-4 inhibitors: Stop prescribing; no patient oriented outcomes
  • Long-acting insulins: Use biosimilar insulin glargine or change patients to NPH
  • LABA/ICS combo inhalers: Change Advair to Symbicort; same effect, less expensive

For more information, please see the table of MAC medications: Maximum Allowable Cost (MAC) Policy — Table Expanded Drug Categories and the Alberta Blue Cross bulletin.


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