State Maximum Allowable Costs (SMAC)
State Maximum Allowable Cost (SMAC) rates are established with the assistance of a vendor, currently Good Health Systems, (GHS), using CMS approved methodology (See Chapter 518 of the Medicaid Manual, Pharmacy Services
). The SMAC rate is applied to both brand and generic drug products in each drug group. Non-AB rated drugs recognized by national drug information suppliers as comparable to a particular brand are subjected to the same SMAC rate applicable to the brand and "AB" rated generic drugs of the same chemical composition, package size, dose, and drug group.
The determination for which drugs will be part of the SMAC list is designated by BMS. SMAC prices are consistently reviewed and revisions to rates made to reflect changes in drug availability and current pricing. New drugs will be added to the SMAC list as they are identified. Pharmacies should complete the form below and submit this form to GHS, along with documentation, when asking for SMAC rates to be reviewed.
SMAC prices may be adjusted retroactively based upon submission of provider documentation. Any changes will be reflected in the effective dates reported in the weekly posted SMAC list. It is providers’ responsibility to access these changes and reprocess claims when appropriate.
Please refer questions to Good Health System (GHS) by email to WVSMAC@ghsinc.com
, phone at (855) 389-9504 or fax to (844) 335-4727.