N.M. Admin. Code § 13.10.30.13

Current through Register Vol. 35, No. 23, December 10, 2024

Section 13.10.30.13 - 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.

N.M. Admin. Code § 13.10.30.13

Adopted by New Mexico Register, Volume XXXII, Issue 02, January 26, 2021, eff. 3/1/2021, Adopted by New Mexico Register, Volume XXXIII, Issue 04, February 22, 2022, eff. 3/1/2022