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Senior Services News Vol. 28, No. 01
Act
by Sep 15, 2025
Effective date
Oct 1, 2025
Identified
Jun 20, 2026
Summary
Effective October 1, 2025, Bausch Health and select AbbVie products are withdrawn from New Jersey's PAAD and Senior Gold prescription assistance programs due to terminated rebate agreements. PAAD and Senior Gold beneficiaries will no longer receive copay assistance for drugs under 47 Bausch Health labeler codes and 3 AbbVie labeler codes; patients will be responsible for full copay costs unless they pursue tier reduction or manufacturer patient assistance programs.
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What to do
by Sep 15, 2025 · 4 steps
01Billing team must update billing system to flag prescriptions for PAAD and Senior Gold beneficiaries containing any of the 50 affected labeler codes (Bausch Health codes 00095, 00187, 00303, 00884, 13548, 14290, 16781, 25010, 49808, 50236, 52725, 57782, 58604, 59987, 61772, 62592, 64455, 65649, 65976, 66490, 66530, 67425, 68012, 68682, 70194, 99207, and AbbVie codes 00051, 58914, 11980).
02Educate providers and front desk staff to notify patients that these medications will incur rejection code 570 (Drug Not Payable – No State Rebate Agreement) starting October 1, 2025.
03Provide patients with alternative resources: (1) request tier reduction from their primary insurance plan, or (2) contact manufacturer patient assistance programs directly (Bausch Health PAP: 1-833-862-8727 or https://www.bauschhealthpap.com/).
04Update claim appeal procedures to document when rejections occur.
If missed: Failure to communicate changes may result in patient confusion, denied claims, and financial burden for beneficiaries.
Original notice
Senior Services News Vol. 28, No. 01
njmmis.com · Always check the source before changing claims.