Page 2866

doses to a recipient in a long-term care facility shall return unused covered outpatient drugs to the pharmacy, and the claim will be adjusted. (k) For covered outpatient drugs described in 7 AAC 120.110(b) and used as home infusion therapy drugs for patients in a long-term care facility, the department will pay a provider 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 state maximum allowable cost for that covered outpatient drug;

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

(4) the estimated acquisition cost for that covered outpatient drug. (l) For covered outpatient drugs described in 7 AAC 120.110(b) and used as home infusion therapy drugs for patients outside a long-term care facility, the department will pay a provider the sum of the covered outpatient drug costs without a dispensing fee, 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 state maximum allowable cost for that covered outpatient drug;

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

(4) the estimated acquisition cost for that covered outpatient drug. (m) If a facility is a covered entity as described in 42 U.S.C. 256b (sec. 340B, Public Health Service Act) and indicates to the United States Department of Health and Human Services that it will use covered outpatient drugs purchased through the 340B drug pricing program under 42 U.S.C. 256b and 42 C.F.R. Part 10 to bill Medicaid, the facility must notify the department and may not submit a charge to Medicaid for more than the actual acquisition cost of the covered outpatient drug and a dispensing fee calculated under 7 AAC 145.410. If a covered entity as described in 42 U.S.C. 256b notifies the United States Department of Health and Human Services, Health Resources and Services Administration, Office of Pharmacy Affairs of any changes in the entity’s enrollment or participation in the program, including that the entity’s pharmacy is not included under 42 U.S.C. 256b, that the entity’s pharmacy is going to begin using covered outpatient drugs purchased through the 340B program to bill Medicaid, or that the pharmacy is no longer going to use covered outpatient drugs purchased through the 340B program to bill Medicaid, the entity shall also notify the department. For covered outpatient drugs from a facility indicating to the United States Department of Health and Human Services that it will use covered outpatient drugs purchased through the 340B drug pricing program to bill Medicaid, the department will pay the lesser of the following:

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