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maximum allowable costs. (e) The payment for covered outpatient drugs described in 7 AAC 120.110(b) is the lowest of the following:

(1) the submitted covered outpatient drug cost plus the dispensing fee set under 7 AAC 145.410;

(2) the federal upper limit established by CMS plus the dispensing fee;

(3) the estimated acquisition cost of the covered outpatient drug plus the dispensing fee;

(4) the state maximum allowable cost plus the dispensing fee. (f) The department will pay for a vaccine product at the rate established in 7 AAC 145.275(1). (g) The payment for brand names of multiple-source drugs that are covered outpatient drugs described in 7 AAC 120.l10(b) and that the prescriber specifies in accordance with 42 C.F.R. 447.512, adopted by reference, is the lowest of the following:

(1) the submitted covered outpatient drug cost plus the dispensing fee set under 7 AAC 145.410;

(2) the estimated acquisition cost of the covered outpatient drug plus the dispensing fee. (h) For a specific covered outpatient drug described in 7 AAC 120.110(b), a provider may not submit a charge to the department in excess of the amount applicable to that drug under 7 AAC 145.020 or the provider’s usual and customary charge for the covered outpatient drug. The usual and customary charge is the lowest amount a provider charges to the general public and reflects all advertised savings, discounts, special promotions, or other programs. The department will pay the lesser of the calculated allowed amount under (e) — (o) of this section less any cost-sharing amount under 7 AAC 105.610, the charged amount submitted under 7 AAC 145.020 less any cost-sharing amount under 7 AAC 105.610, or the provider’s usual and customary charge less any cost-sharing amount under 7 AAC 105.610. (i) For a compounded prescription that contains one or more covered outpatient drugs described in 7 AAC 120.110(b), the department will pay the sum of the dispensing fee set under 7 AAC 145.410 and the cost of each covered outpatient drug, with the cost of each covered outpatient drug set at the lowest of the following:

(1) the submitted cost for that covered outpatient drug;

(2) the federal upper limit established by CMS for that covered outpatient drug;

(3) the state maximum allowable cost for that covered outpatient drug;

(4) the estimated acquisition cost for that covered outpatient drug. (j) A provider that dispenses covered outpatient drugs described in 7 AAC 120.110(b) in unit