MedicaidCoverageMedium impact
Newsletter Vol. 27, No.06
New Jersey Medicaid·NJ · Family Medicine, Internal Medicine, General Practice +1 more·Medical Policy
Effective date
Jul 1, 2017
We identified it
Jun 20, 2026
Summary
NJ FamilyCare (New Jersey Medicaid) clarifies that over-the-counter smoking cessation products (nicotine gum, lozenges, patches) ARE covered by their program. For dual-eligible beneficiaries, billing teams must submit OTC smoking cessation claims to Medicaid first, not Medicare Part D, and must use proper NDC codes instead of UPC codes.
Action Required
Immediately: Billing team must update pharmacy billing procedures for NJ FamilyCare beneficiaries. For dual-eligible patients needing OTC smoking cessation products, submit claims to Molina Medicaid Solutions (FFS) or NJFC managed care plans as primary payer, NOT Medicare Part D. Ensure proper NDC codes are used for billing, never UPC codes. Verify manufacturer has signed federal Medicaid Drug Rebate Agreement before dispensing. Contact MEP Unit at 1-877-888-2939 for FFS claim denials or HMO pharmacy plan for clarification before telling patients products aren't covered.