MedicaidCoverageMedium impact
Newsletter Vol. 32, No.16
New Jersey Medicaid·NJ · Family Medicine, Internal Medicine, General Practice +1 more·Eligibility
We identified it
Jun 20, 2026
Summary
New Jersey Medicaid/NJ FamilyCare now covers at-home COVID-19 test kits with specific limits: up to 8 tests per month without prescription, and unlimited tests with a prescription when medically necessary. Pharmacies must bill through NCPDP D.0 claims and exhaust other insurance options first.
Action Required
Immediately: Pharmacy staff must update billing procedures to submit at-home COVID test kit claims through NCPDP D.0 Point-Of-Sale system for NJ Medicaid members. Verify other insurance coverage (Medicare Part B/D) before billing Medicaid. Track monthly limits: maximum 8 tests without prescription, unlimited with valid prescription for medical necessity. Contact Gainwell Technologies at 1-877-888-2939 for quantities over 8 tests per month.