Alaska Administrative Code
Title 7 - Health and Social Services
Part 8 - Medicaid Coverage and Payment
Chapter 120 - Medicaid Coverage; Prescription Drugs and Medical Supplies; Durable Medical Equipment; Prosthetics and Orthotics Transportation Services
Article 1 - Prescription Drugs and Medical Supplies
7 AAC 120.112 - Non-covered drugs

Universal Citation: 7 AK Admin Code 120.112

Current through November 28, 2024

Notwithstanding 7 AAC 120.110, the department will not pay for

(1) a drug used to treat infertility, obesity, or baldness;

(2) a hair or wrinkle remover;

(3) a drug that is not a covered outpatient drug under 7 AAC 120.110(b);

(4) a covered outpatient drug under 7 AAC 120.110(b) for which more than a 34-day supply is ordered per prescription unless the covered outpatient drug is listed on the department's Alaska Medicaid 90 Day Generic Prescription Medication List, adopted by reference in 7 AAC 160.900;

(5) a drug used for the symptomatic relief of coughs and colds;

(6) a non-prescription drug, vitamin, or dietary or herbal supplement, except as listed in 7 AAC 120.110(a)(4);

(7) a brand-name covered outpatient drug described in 7 AAC 120.110(b) if a therapeutically equivalent generic covered outpatient drug is on the market, unless

(A) the brand-name covered outpatient drug is included as a preferred medication on the Alaska Medicaid Preferred Drug List, adopted by reference in 7 AAC 160.900; or

(B) the prescriber writes on the prescription "brand-name medically necessary"; the information may be submitted electronically or telephonically; if the information is submitted telephonically, the prescriber must document it in the recipient's record; the department may require prior authorization under 7 AAC 120.130 for a brand-name covered outpatient drug with a therapeutically equivalent generic covered outpatient drug on the market; or

(8) a covered outpatient drug described in 7 AAC 120.110(b) for which, as described in 7 AAC 105.110(18), payment under CMS' drug rebate program is unavailable;

(9) a drug that is

(A) prescribed by a provider who is not enrolled under 7 AAC 105.210; or

(B) not prescribed in accordance with 7 AAC 105.220(a), regardless of whether the drug would otherwise be covered.

Authority:AS 47.05.010

AS 47.07.030

AS 47.07.040

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