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Senior Services News Vol. 27, No. 02
New Jersey Medicaid·NJ · Pharmacy, Geriatrics·Pharmacy
Effective date
Nov 1, 2024
We identified it
Jun 20, 2026
Summary
Effective November 1, 2024, Merck has terminated its rebate agreement with New Jersey's PAAD and Senior Gold prescription assistance programs. All Merck-manufactured drugs (identified by labeler codes 00006, 00052, 00085, 11523) will no longer be covered by these programs, and claims will be rejected with code 570. Patients will be responsible for full copay costs unless they obtain tier reduction from primary insurance or enroll in Merck's patient assistance program.
Action Required
By November 1, 2024: Billing team must update claims processing system to recognize rejection code 570 (Drug Not Payable – No State Rebate Agreement / NCPDP AC) for all Merck products under labeler codes 00006, 00052, 00085, and 11523. Implement alerts when PAAD or Senior Gold beneficiaries attempt to fill Merck medications post-November 1. Train front-desk and billing staff to inform affected patients that they will owe full copays for Merck products and direct them to request tier reduction from their primary plan or contact Merck Patient Assistance Program (1-800-727-5400 or www.merckhelps.com). Update patient statements and EOBs to reflect coverage denial for Merck products. Failure to process these rejections correctly will delay claim resolution and create patient billing confusion.