MedicaidPrior AuthMedium impact
Newsletter Vol. 32, No.11
New Jersey Medicaid·NJ · Infectious Disease, General Practice, Family Medicine +2 more·Prior Authorization
Effective date
Apr 1, 2022
We identified it
Jun 20, 2026
Summary
New Jersey Medicaid implemented a prior authorization exclusion protocol for ivermectin (Stromectol®) effective immediately. Ivermectin is now approved for FDA-approved indications only, limited to 6 tablets (3mg each) per 90 days, with higher doses requiring documented medical necessity. Off-label use for COVID-19 treatment is no longer covered due to safety concerns.
Action Required
Immediately: (1) Billing team must update prior authorization rules in the billing system to reject or flag any ivermectin claims exceeding 6 tablets (3mg) per 90 days unless medical necessity documentation is provided. (2) Update claim submission protocols to require prior auth verification before processing ivermectin prescriptions. (3) Providers must be notified that ivermectin will only be approved for FDA-approved parasitic infections, head lice, and skin conditions—NOT for COVID-19 or other off-label uses. (4) Create a hold/review process in the billing system for any ivermectin claims to ensure compliance with the 6-tablet limit. (5) Staff should educate patients about alternative COVID-19 treatments using provided FDA resources. Claims submitted outside these parameters will be denied by the payer.