MedicaidCoverageMedium impact
Newsletter Vol. 28, No.12
New Jersey Medicaid·NJ · Pain Management, Pharmacy, Internal Medicine +2 more·Provider Notice
Effective date
Jul 1, 2018
We identified it
Jun 20, 2026
Summary
New Jersey's Drug Utilization Review Board issued educational guidance for prescribers to use Morphine Milligram Equivalents (MMEs) when prescribing opioids to Medicaid beneficiaries. The policy recommends limiting cumulative daily MME doses to 90-120 mg (CDC guideline) with consideration for denial above 200 mg daily (CMS/state Medicaid recommendation). This is informational guidance, not a mandatory coverage denial policy, but signals New Jersey's opioid prescribing standards for state beneficiaries.
Action Required
By August 2018: Billing and clinical teams should review this educational newsletter and ensure providers are aware of MME conversion factors and dosing recommendations. No immediate billing system changes required, but billing team should be prepared to flag claims for opioid prescriptions exceeding 200 mg daily cumulative MME for New Jersey Medicaid beneficiaries, as these may be subject to coverage review or denial by the state Medicaid agency. Establish internal audit process to identify high-dose opioid claims (>200 mg MME daily) for prior authorization monitoring. Retain this newsletter for reference when processing NJ Medicaid pharmacy and pain management claims.