MedicaidReimbursementLow impact
Newsletter Vol. 27, No.03
New Jersey Medicaid·NJ·Eligibility
Effective date
Apr 1, 2017
We identified it
Jun 20, 2026
Summary
New Jersey is implementing new pharmacy reimbursement rules under the Covered Outpatient Drug Rule, changing from Estimated Acquisition Cost to Actual Acquisition Cost pricing and replacing dispensing fees with professional fees. This affects NJ FamilyCare (April 1, 2017) and PAAD/Senior Gold programs (July 1, 2017).
Action Required
This policy change only affects pharmacy billing for New Jersey Medicaid programs and does not impact medical billing practices. No action required for medical billing teams outside of pharmacy services.