Section 7 AAC 120.110 - Covered outpatient drugs and home infusion therapy(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.Eff. 2/1/2010, Register 193; am 6/13/2010, Register 194; am 7/7/2010, Register 195; am 1/1/2011, Register 196; am 9/7/2011, Register 199; am 1/4/2012, Register 201; am 5/18/2014, Register 210, July 2014; am 4/24/2020, Register 234, April 2020; am 1/10/2021, Register 237, April 2021; am 3/3/2023, Register 245, April 2023Authority:AS 47.05.010
AS 47.07.030
AS 47.07.040