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(A) at least one ingredient is a covered outpatient drug and the recipient’s drug therapy needs cannot be met by commercially available dosage strengths or forms of the therapy;

(B) the claim for a compounded prescription is submitted using the national drug code (NDC) number and quantity for each covered outpatient drug in the compound;

(C) not more than 25 covered outpatient drugs are reimbursed in any compound; and

(D) reimbursement for each covered outpatient drug is determined in accordance with 7 AAC 145.400;

(3) insulin;

(4) except for a recipient who resides in a long-term care facility or an intermediate care facility for the intellectually and developmentally disabled, the following U.S. Food and Drug Administration regulated products that have been prescribed, even if that product may be sold without a prescription:

(A) prenatal vitamins for pregnant and nursing women;

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

(C) respiratory saline products;

(D) repealed 3/3/2023;

(E) loratadine;

(F) fexofenadine;

(G) cetirizine.

(H) naloxone;

(I) for any recipient