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

(3) the estimated acquisition cost plus the dispensing fee;

(4) the state maximum allowable cost plus the dispensing fee. (n) For purposes of (m) of this section, actual acquisition covered outpatient drug cost is the unit cost that the facility pays for a drug, after subtracting all discounts. A facility may establish written protocols for establishing or calculating the facility’s actual acquisition drug cost based on a monthly, quarterly, or other average of the facility’s actual acquisition drug cost. A written protocol may not include an inflation, mark-up, spread, or margin to be added to the facility’s actual purchase price after subtracting all discounts. (o) If a facility purchases drugs through the Federal Supply Schedule of the United States General Services Administration or drug pricing program under 38 U.S.C. 8126, 42 U.S.C. 256b, or 42 U.S.C. 1396r-8, other than through the 340B drug pricing program under 42 U.S.C. 256b and 42 C.F.R. Part 10, the facility shall notify the department. The facility shall notify the department of any changes in participation in purchasing drugs through the Federal Supply Schedule or drug pricing program under 38 U.S.C. 8126, 42 U.S.C. 256b, or 42 U.S.C. 1396r-8. For covered outpatient drugs from a facility purchasing drugs through the Federal Supply Schedule or drug pricing program under 38 U.S.C. 8126, 42 U.S.C. 256b, or 42 U.S.C. 1396r-8 other than through the 340B drug pricing program, the department will pay the lesser 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 wholesale acquisition cost of the covered outpatient drug minus 15 percent plus the dispensing fee;

(4) the state maximum allowable cost plus the dispensing fee. (p) In this section,

(1) “estimated acquisition cost” means the wholesale acquisition cost plus one percent;

(2) “home infusion therapy”

(A) means drugs that require the use of a laminar flow hood or clean room for the protection of either the product or preparing personnel;

(B) includes cancer chemotherapy drugs, intravenous antibiotics, and hyperalimentation drugs;

(3) “wholesale acquisition cost” means the manufacturer’s list price for the drug to wholesalers or direct purchasers in the United States, not including prompt-pay or other discounts, rebates, or reductions in price, for the most recent month for which the information is