Current through November 28, 2024
(a) Except as
provided in
7
AAC 120.112, the department will pay for
(1) a covered outpatient drug described in
(b) of this section;
(2) a
compounded prescription, if
(A) at least one
ingredient is a covered outpatient drug and the recipient's drug therapy needs
cannot be met by commercially available dosage strengths or forms of the
therapy;
(B) the claim for a
compounded prescription is submitted using the national drug code (NDC) number
and quantity for each covered outpatient drug in the compound;
(C) not more than 25 covered outpatient drugs
are reimbursed in any compound; and
(D) reimbursement for each covered outpatient
drug is determined in accordance with
7
AAC 145.400;
(4) except for a recipient who resides in a
long-term care facility or an intermediate care facility for the intellectually
and developmentally disabled, the following U.S. Food and Drug Administration
regulated products that have been prescribed, even if that product may be sold
without a prescription:
(A) prenatal vitamins
for pregnant and nursing women;
(B)
nonoxynol-9 contraceptive creams, gels, foams, and sponges;
(C) respiratory saline products;
(I) for any recipient
(i) a
preventive service product consistent with
7
AAC 110.800;
(ii) a medical countermeasure drug or biological
product related to a disaster declaration or declaration of national emergency
under 42 U.S.C.
5121-
5207 (Stafford Disaster Relief and
Emergency Assistance Act) or 50 U.S.C. 1601-
1651 (National Emergencies Act)
authorized for emergency use under
21 U.S.C.
360bb b-3 (sec. 564, Federal Food, Drug, and
Cosmetic Act).
(b) To be a covered outpatient drug, a drug
must be one
(1) that may be dispensed only
upon a prescription;
(2) for which
the United States Food and Drug Administration (FDA) requires a national drug
code (NDC) number;
(3) that is
listed electronically with the FDA;
(4) that is a covered outpatient drug with
the meaning given in 42
C.F.R. 447.502 (definitions; covered
outpatient drug), adopted by reference in
7
AAC 160.900(b); and
(5) for which federal Medicaid matching funds
are available.
(c) The
department will pay an eligible provider enrolled under 7 AAC 105-7 AAC 160 for
specialized patient medication counseling provided by an affiliated pharmacist,
not more than once each 30-day period for a recipient, if
(1) the service is within the scope of the
pharmacist's license, training, and competency;
(2) documentation is maintained consistent
with 7 AAC 105.230;
(3) the service is identified as reimbursable
on the
Pharmacist Renderer Fee Schedule, adopted by reference
in 7 AAC 160.900; and
(4) the pharmacist is enrolled under 7 AAC
105-7 AAC 160.
(d) The
department will pay for a vaccine product and administration in accordance with
7
AAC 110.750 if provided to a recipient by a licensed
or registered pharmacist acting within that pharmacist's scope of practice
under state law
(e) For purposes of
billing for a covered outpatient drug described in (b) of this section, the
date of service is the date a prescription is filled. If the recipient or the
recipient's representative does not receive the covered outpatient drug during
the 10-day period that begins on the date the prescription is filled, the
pharmacy shall reverse the claim and refund the payment to the
department.
(f) A pharmacy shall
maintain documentation of receipt by a recipient of a covered outpatient drug
described in (b) of this section. The documentation may be kept as a signature
log showing which prescription numbers are received or as mailing labels if
covered outpatient drugs are mailed to the recipient.
Authority:AS
47.05.010
AS 47.07.030
AS
47.07.040
