MedicaidCoverageMedium impact
Newsletter Vol. 33, No.17
New Jersey Medicaid·NJ · Pharmacy·Provider Notice
Effective date
Oct 1, 2023
We identified it
Jun 20, 2026
Summary
New Jersey's Naloxone365 program now covers both FDA-approved legend and over-the-counter (OTC) naloxone 4 mg nasal spray for any NJ resident age 14 or older, regardless of Medicaid eligibility. Pharmacies can now use their pharmacy NPI in the prescriber ID field for OTC naloxone claims since no standing order exists. Reimbursement is based on the lowest of NADAC, WAC minus 2%, or SUL plus a $10.92 dispensing fee, or usual and customary charge.
Action Required
Effective immediately: Pharmacy billing staff must update systems to process both legend and OTC naloxone 4 mg nasal spray products under the Naloxone365 program. When submitting OTC naloxone claims, populate NCPDP Prescriber ID field (411-DVB) with the pharmacy's NPI instead of a physician prescriber ID. Verify reimbursement calculations use the lowest of: NADAC, WAC minus 2%, or SUL plus $10.92 dispensing fee, or the pharmacy's usual and customary charge. Reference prior guidance in Medicaid Newsletter Volume 33, No. 1 for complete billing requirements. Contact Gainwell Technologies Provider Services at 1-800-776-6334 with questions.