MedicaidCoverageMedium impact
Newsletter Vol. 33, No.01
New Jersey Medicaid·NJ · Pharmacy·Provider Notice
Effective date
Jan 1, 2023
We identified it
Jun 20, 2026
Summary
New Jersey DHS has launched Naloxone365, a program allowing pharmacies to dispense free naloxone anonymously to any NJ resident age 14+ regardless of Medicaid eligibility. Pharmacies billing NJFC/Medicaid FFS must use standardized placeholder patient information (Jane Doe, DOB 010199) and a specific recipient ID (580200000020) to request reimbursement. This applies to FDA-approved 4mg naloxone nasal spray products only, with one 2-spray package per dispense and no weekly limit.
Action Required
By January 1, 2023: Pharmacy billing team must implement Naloxone365 billing procedures if dispensing anonymous naloxone. (1) Configure billing system to route naloxone claims to BIN 610515 only for anonymous dispensing. (2) Update claim submission templates to automatically populate NCPDP fields with: Patient First Name (310-CA) = 'Jane', Patient Last Name (311-CB) = 'Doe', Date of Birth (304-C4) = '010199', Cardholder ID = '5802000000' (10 bytes), Person Code = '20' (2 bytes). (3) Configure prescriber ID field (411-DVB) with NJ Department of Health standing order NPI. (4) Restrict coverage to FDA-approved 4mg naloxone nasal spray products only. (5) Limit to one 2-spray package per dispense, each with unique prescription number. (6) Verify patients are community residents (not nursing facility residents) before billing. (7) Train pharmacy staff that when naloxone is requested with a specific Medicaid member ID, standard billing requirements apply instead. Consequences: Claims billed incorrectly may be subject to retrospective review and recovery by DMAHS.