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(a) The division of medical assistance may not pay for a brand-name prescription drug if an FDA-approved generic drug of equal therapeutic effectiveness is available, unless the prescriber prohibits substitution.
(b) The division of medical assistance may only pay for prescription drugs and medical supplies prescribed to treat a person who
(1) repealed 7/1/87;
(2) has a terminal illness;
(3) has cancer and requires chemotherapy; or
(4) has a specific chronic condition that would normally in its untreated course result in the death or disability of the recipient, but which is amenable to outpatient medication; the chronic conditions for which drugs will be reimbursed are limited to the following diagnoses:
(A) diabetes and diabetes insipidus;
(B) seizure disorders;
(C) chronic mental illness;
(D) hypertension.
(c) Reimbursement to providers will be that computed under 7 AAC 43.591 for the medicaid program.
(d) The division of medical assistance may not pay for more than a 30-day supply of a prescribed drug unless prior authorization has been obtained by the pharmacist from the division of medical assistance.
(e) The division of medical assistance may not pay for non-prescription drugs, except insulin. The division of medical assistance may grant an exception based on written information submitted on a request for authorization form, which is available from the division of medical assistance.
(f) The division of medical assistance may only pay for prescribed medical supplies that have been assigned a current specific billing code number by the division of medical assistance. The division of medical assistance may grant an exception based on written information submitted on a request for authorization form, which is available from the division of medical assistance.
History: Eff. 8/1/86, Register 99; am 11/28/86, Register 100; am 7/1/87, Register 103; am 2/1/89, Register 109; am 6/14/89, Register 110
Authority: Chapter 120, SLA
1988
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Last modified 7/05/2006