Notwithstanding 7 AAC 120.110, the department will not pay for

1. (1) a drug used to treat infertility, obesity, or baldness;
2. (2) a hair or wrinkle remover;
3. (3) a drug that is not a covered outpatient drug under 7 AAC 120.110(b);
4. (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. (5) a drug used for the symptomatic relief of coughs and colds;
6. (6) a non-prescription drug, vitamin, or dietary or herbal supplement, except as listed in 7 AAC 120.110(a)(4);

7. (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

   1. (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
   2. (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. (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. (9) a covered outpatient drug described in 7 AAC 120.110(b) used in a qualifying clinical trial defined in 7 AAC 160.900, not considered to be a routine patient cost as defined in 7 AAC 160.900 including those drugs used in trials designed exclusively to test toxicity or disease pathophysiology.

10. (10) a drug that is

    1. (A) prescribed by a provider who is not enrolled under 7 AAC 105.210; or
    2. (B) not prescribed in accordance with 7 AAC 105.220(a), regardless of whether the drug would otherwise be covered.

(Eff. 5/18/2014, Register 210; am 5/19/2023, Register 246; am 3/1/2024, Register 249)

Authority: AS 47.05.010, AS 47.07.030, AS 47.07.040