About AHC's MAC Appeals Portal

This portal was design to help facilitate the MAC appeal process between American Health Care and our Pharmacy partners.

How does the MAC Appeal process work?

All MAC appeals must be submitted via our MAC Appeals Portal. The appeal should be for generic products only. Claims for a date of fill for more than 30 days from today’s date may not be reviewed.

Claims being reimbursed at contracted AWP discounts, submitted Usual & Customary or Submitted Ingredient Cost do NOT qualify for review or appeals.

Pharmacies contracted directly with American Health Care may appeal directly to American Health Care. If your pharmacy is part of a chain, franchise, third party network or PSAO, please direct your appeals to your corporate office or third party network administrator.

The following information is required when submitting a MAC appeal:

  1. Pharmacy Information
    • Pharmacy Name
    • Pharmacy NPI
    • Pharmacy NABP
  2. Claim Information
    • Rx Number
    • Fill Date
    • Generic Drug Verifier
    • Dispense Fee
    • Total Paid
    • RxGroup Number
    • NDC Number
    • Member ID
    • Member DOB
    • Drug Name, Formulation & Strength
    • Quantity Dispensed
    • U & C Price
    • Acquisition Cost
    • Comments
  3. Please include a copy of your invoice or proof of acquisition cost of NDC must accompany this request. NDC in question must be from pharmacy’s primary wholesaler for that NDC, and should be the lowest acquisition cost the pharmacy can purchase for that product.