Alaska Administrative Code
Title 7 - Health and Social Services
Part 8 - Medicaid Coverage and Payment
Chapter 145 - Medicaid Payment Rates
Article 5 - Payment Rates; Prescription Drugs and Medical Supplies; Durable Medical Equipment; Transportation; Laboratory Services
7 AAC 145.410 - Dispensing fee

(a) Except as provided under (b) of this section, and in accordance with the following, the department will pay a dispensing fee for a covered outpatient drug if the claim satisfies all coverage criteria under 7 AAC 120.110 - 7 AAC 120.140:

(b) The department will pay, under (a), (c), or (g) of this section, the lesser of the assigned dispensing fee or the submitted dispensing fee.

(c) Upon request by the department, a pharmacy shall produce business records and invoice information relevant to the cost of drugs and the cost of dispensing. If a pharmacy does not provide cost of drugs or dispensing fee data as requested by the department, the department may assign that pharmacy the dispensing fee of $3.45 and sanction the pharmacy as provided under 7 AAC 105.400 - 7 AAC 105.490.

(d) A pharmacy may not refuse to fill an interim prescription for a covered outpatient drug occurring before the end of the 14 or 22 days as applicable under (a)(1) - (5) of this section because an additional dispensing fee will not be paid.

(e) In addition to a dispensing fee under (a) - (c) of this section for a tobacco cessation covered outpatient drug, the department will pay for tobacco cessation medication therapy management that meets the requirements of 7 AAC 120.110(c) at the rate of $16, not more than once every 30 days.

(f) The department will pay for the administration of a vaccine product covered under 7 AAC 110.750 at the rate established in 7 AAC 145.275(2).

(g) A claim for a covered outpatient drug dispensed by a dispensing provider to a recipient for outpatient use will be reimbursed in accordance with 7 AAC 145.400 with no dispensing fee. A covered outpatient drug administered to an outpatient recipient by a physician, advanced practice registered nurse practitioner, or physician assistant, and billed using a covered code under the Current Procedural Terminology (CPT) or Healthcare Common Procedure Coding System (HCPCS), adopted by reference in 7 AAC 160.900, will be reimbursed at the estimated acquisition cost defined in 7 AAC 145.400(p) for the amount administered with no dispensing fee. For state fiscal year 2020, starting on the later of August 1, 2019, or after a 30 day notice to the providers, a covered outpatient drug administered to an outpatient recipient by a physician, advanced practice registered nurse, or physician assistant that is not enrolled in the MMIS as a provider type or provider specialty identified in 7 AAC 145.050(c) and who is identified as the rendering provider on the claim submitted to the MMIS billed using a covered CPT or HCPCS code will be reimbursed at 95 percent of the estimated acquisition cost defined in 7 AAC 145.400(p) with no dispensing fee.

(h) In this section,