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.
Notes
Authority:AS 23.30.005
AS 23.30.095
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