7 AAC 43.590. Drug coverage

(a) The department will pay for

(1) a drug that requires a prescription, except for a drug excluded under (b) of this section;

(2) a drug that the United States Drug Enforcement Agency has categorized as a Schedule V Narcotic under 21 C.F.R. 1308.15;

(3) a compounded prescription, if at least one ingredient requires a prescription for dispensing or is a Schedule V Narcotic as described in (2) of this subsection;

(4) insulin;

(5) except for a recipient who is in a long-term care facility or an intermediate care facility for the mentally retarded, a drug that has been prescribed even if that drug may be sold without a prescription, as follows:

(A) laxatives and bismuth preparations;

(B) clotrimazole and miconazole vaginal creams and suppositories;

(D) nonoxynol 9 contraceptive creams, gels, foams, and sponges;

(E) respiratory saline products;

(F) bacitracin ointment;

(G) ferrous sulfate and ferrous gluconate in non-sustained release forms; and

(H) debrisin and compounds for decubitus ulcers that contain sugar, providone iodine, or aluminum chlorhydrate; and

(6) growth hormones, if prior authorization has been obtained, that are prescribed for a medically accepted indication for the treatment of children with growth failure

(A) due to a lack of adequate endogenous human growth hormone secretion; or

(B) associated with chronic renal insufficiency up to the time of renal transplantation.

(b) The department will not pay for the following:

(1) drugs used to treat infertility, obesity, and baldness;

(2) drugs that are prohibited from receiving federal Medicaid matching funds under 42 C.F.R. 441.25, as amended October 1, 1981;

(3) drugs, except for birth control drugs and drugs listed in (a)(5) of this section if dispensed in an unopened container, for which more than a 30-day supply is ordered per prescription;

(4) repealed 9/29/2005;

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

(6) oral vitamins, except prenatal, fluoride preparations, folic acid, Vitamin A, Vitamin K, Vitamin D, and analogs; and

(7) brand name, multi-source drugs if a therapeutically equivalent generic drug is on the market, unless the prescriber writes on the prescription "brand-name medically necessary drug" or "allergic to the inert ingredients of the generic drug"; the information may be submitted electronically or telephonically; if the information is submitted telephonically, it must be documented by the prescriber in the recipients's record.

(1) "growth failure" means the lack of growth in a child indicated by a stature two or more standard deviations below the mean or below the third percentile for height on a standard growth chart;

(2) "medically accepted indication" means any use for a covered outpatient drug that is

(A) approved under 21 U.S.C. 301 - 392 (Food, Drug, and Cosmetic Act); or

(B) is supported by one or more citations included or approved for inclusion in the compendia of the American Hospital Formulary Service Drug Information , the United States Pharmacopeia-Drug Information , or the American Medical Association Drug Evaluations .

History: Eff. 8/1/86, Register 99; am 12/28/86, Register 100; am 2/1/89, Register 109; am 6/14/89, Register 110; am 11/18/93, Register 128; am 3/13/94, Register 129; am 6/2/95, Register 134; readopt 8/7/96, Register 139; am 9/29/2005, Register 175

Authority: AS 47.05.010

AS 47.07.030

AS 47.07.040

AS 47.07.050

Editor's note: Effective 8/7/96, Register 139, the Department of Health and Social Services readopted 7 AAC 43.590 in its entirety, without change, under AS 47.05 and AS 47.07. Executive Order No. 72 transferred certain rate-setting authority to the department.

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