Innoviant MAC Override Requests

If your pharmacy dispenses a generic product that is on our MAC list and you experience a negative reimbursement, let us know.

It's as easy as 1,2,3. Simply complete the MAC Override request form and fax it back to the number on the form.

Innoviant MAC Pricing Research Request Form

It is our goal to provide you a response via return phone call within seven business days after receiving your faxed request. If the NDC is approved for repricing, it should be available to reprocess within 5-7 business days.

Reminder of Requirements

1. Fill in pharmacy information and claim information completely or attach copy of claim (if copy contains the key information).
2. Provide proof of acquisition price.
3. NDC in question must be from your primary wholesaler to be eligibile for consideration. List your wholesaler in comments section please.

Helpful reminders

• Pre-fill your pharmacy's information and make a photocopy of form. Retain copies on file to reduce filling in duplicate information each time you have a request.
• You may attach a copy of the claim in question (if it includes the required information) rather than completing form manually.
• If you have this form, there is no need in the future to call in a request to our customer service center. Just fill out form and fax. We will take care of the rest. Expect a call back from Innoviant within seven business days.
• If you have questions, please call the Innoviant customer service center at 877.559.2955 (The Innoviant customer service department is available to answer your calls 24 hours a day, seven days a week).