MedicaidCoverageMedium impact
Newsletter Vol. 23, No.13
New Jersey Medicaid·NJ·Provider Notice
Effective date
Aug 1, 2013
We identified it
Jun 20, 2026
Summary
New Jersey Medicaid immediately discontinued coverage of active pharmaceutical ingredients (APIs) and excipients used in compound prescriptions. Pharmacies can no longer bill Medicaid for these bulk substances but can charge patients directly for non-covered ingredients.
Action Required
Immediately: Billing team must stop submitting claims to NJ Medicaid for APIs and excipients used in compound prescriptions. Update billing system to use Submission Clarification Code '08' in NCPDP Field 420-DK when resubmitting compound claims with non-covered ingredients. Review NDC list at njmmis.com under 'Rate and Code Information' for non-covered APIs/Excipients. Notify patients they will be responsible for paying out-of-pocket for non-covered bulk ingredients in compound prescriptions.