MedicaidCoverageHigh impact
Newsletter Vol. 27, No.04
New Jersey Medicaid·NJ · Pharmacy·Medical Policy
Effective date
Apr 1, 2017
We identified it
Jun 20, 2026
Summary
New Jersey is establishing state coverage and reimbursement procedures for 340B Drug Discount Program prescriptions under NJ FamilyCare and ADDP pharmacy programs. Pharmacies operated by covered entities (DSH hospitals, FQHCs, independent clinics) must now report 340B drugs using NCPDP code '08' in Field 423-DN and will be subject to claim-level edits to prevent duplicate manufacturer rebates. Contract pharmacies are explicitly ineligible for 340B reimbursement.
Action Required
By March 31, 2017: Billing team must verify whether your practice qualifies as a 340B covered entity (DSH hospital, FQHC, or authorized independent clinic). If eligible, configure pharmacy billing system to report NCPDP Basis of Cost Determination code '08' (Field 423-DN) on all 340B drug claims effective April 1, 2017 (or July 1, 2017 for ADDP claims). Pharmacy staff must accurately identify 340B inventory at point of dispensing to ensure correct claim submission. Establish internal procedures to verify 340B-eligible beneficiaries per covered entity definition. If using contract pharmacies, stop submitting 340B claims for those entities—only pharmacy operations directly owned by the covered entity are eligible. Monitor for Edit Code 2297 on submitted claims. Document responsibility for accurate claim coding, as the covered entity will be held liable for payment recovery if manufacturers dispute claims due to incorrect identifiers. Contact Molina Medicaid Solutions at 1-800-776-6334 with implementation questions.