8 Alaska Admin. Code § 45.081

Current through April 27, 2024

Section 8 AAC 45.081 - Dispensing of generic drug products

(a) When filling a prescription provided to an employee as a medical benefit under the Act, an available generic drug product must be dispensed in place of a name-brand drug product when the cost of the generic drug product is less, except that a name-brand drug product that is more expensive than an available generic drug product may be dispensed if the prescribing physician has provided a written justification of the medical necessity for dispensing the name-brand drug product as described in this section. A notation that the prescription for the name-brand drug product must be dispensed only as written is not a sufficient justification of medical necessity.

(b) The prescribing physician must prepare the written justification of the medical necessity of dispensing a name-brand drug product and submit the written justification along with the prescription to the dispensing pharmacist and the insurer. The written justification does not need to be submitted to the dispensing pharmacist if the prescription itself expressly notes that the prescription is being provided as a medical benefit under the Act and that a written justification of the medical necessity for dispensing a name-brand drug product has been submitted to the insurer.

(c) A written justification of the medical necessity for dispensing the name-brand drug product may include any of the following factors regarding the employee:

(1) treatment failure with the generic drug product;

(2) past medical history that suggests an anticipated treatment failure with the generic drug product;

(3) clinically significant adverse reaction to the generic drug product;

(4) a medical condition that causes a contraindication for the use of the generic drug product;

(5) allergic reaction to the generic drug product.

(d) An employee may choose to have a name-brand drug product dispensed, even if a less costly generic drug product is available and no written justification of medical necessity has been provided. The difference in cost between the generic drug product and name-brand drug product must be paid by the employee and neither the employer or the employer's insurer is liable for reimbursing the employee for the additional cost.

(e) The Alaska Medicaid Preferred Drug List, Version 111809, revised as of November 18, 2009, is adopted by references as the preferred drug list for purposes of the Act.

8 AAC 45.081

Eff. 7/31/2010, Register 195

Authority:AS 23.30.005

AS 23.30.095