On Medium- High heat, melt your butter, and add your flour, tablespoon at a time, constantly whisking to make a roux.
Add in your tomato paste and whisk followed by your heavy cream, and whisk constantly until all smooth, bring to a boil for about 30 seconds to a minute and let thicken.
Add in your Tony Cachere's and Hot Sauce of your choice, and salt and pepper to taste. Make sure to taste as you go after each of these items to make sure its tasting to your liking.
Add your cooked macaroni noodles, and stir to coat.